Is 200 mg of fluconazole (fluconazole) for 14 days an appropriate treatment for a 96-year-old male with a positive yeast culture, symptomatic and recently removed catheter, and normal kidney and liver function?

Treatment of Catheter-Related Yeast Infection in a 96-Year-Old Male

Yes, fluconazole 200 mg daily for 14 days is appropriate for this 96-year-old male with symptomatic yeast infection following catheter removal, given his normal kidney and liver function. 1

Rationale for Treatment

• Catheter-related Candida infections require antifungal therapy for all cases, even when clinical manifestations resolve after catheter removal 1
• For hemodynamically stable patients who have not had recent fluconazole therapy, fluconazole is the recommended first-line treatment 1
• The recommended duration of antifungal treatment for candidemia is 14 days after the last positive blood culture result and resolution of symptoms 1
• Fluconazole administered at 400 mg daily for 14 days is equivalent to amphotericin B in treating candidemia caused by Candida albicans and azole-susceptible strains 1

Dosing Considerations for Elderly Patients

• The standard dose of 200 mg daily is appropriate since the patient has normal kidney and liver function 1, 2
• Fluconazole is generally well tolerated, which is important for elderly patients 2
• No dose adjustment is required based on age alone when renal function is normal 2

Management Algorithm

1. Confirm catheter removal has been completed

   • Catheter removal is strongly recommended in cases of CRBSI due to Candida species 1
   • All prospective studies show that catheter retention worsens outcomes 1

2. Initiate antifungal therapy

   • Fluconazole 200 mg daily for 14 days 1
   • Monitor for clinical improvement within 72 hours 1

3. Obtain follow-up cultures

   • Consider repeat blood cultures to confirm clearance of infection 1
   • Treatment should continue for 14 days after the first negative blood culture 1

4. Monitor for adverse effects

   • Watch for hepatic reactions, which can range from mild transient elevations in transaminases to clinical hepatitis 2
   • Monitor for drug interactions if the patient is on other medications 2

Special Considerations for This Patient

• Advanced age (96 years) requires careful monitoring for adverse effects, though fluconazole is generally well-tolerated 2
• The recent catheter removal was appropriate management as catheter removal is strongly recommended for all Candida infections 1
• Normal kidney and liver function allows for standard dosing without adjustment 2

Common Pitfalls to Avoid

• Failure to treat for the full 14-day course even if symptoms resolve quickly 1
• Not monitoring for potential drug interactions, as fluconazole can interact with warfarin, phenytoin, oral hypoglycemics, and other medications 2
• Inadequate follow-up to confirm infection clearance 1
• Using echinocandins or newer azoles for urinary tract yeast infections, as these fail to achieve adequate urine concentrations 3