Fluconazole Dosage for Penile Prosthesis Surgery
For patients undergoing penile prosthesis insertion, oral fluconazole should be administered at a dose of 400 mg (6 mg/kg) daily for several days before and after the procedure to prevent fungal infections. 1
Dosage Protocol
- Fluconazole 400 mg (6 mg/kg) daily is the recommended dose for patients undergoing urologic procedures, including penile implant surgery 1, 2
- The administration should begin several days before the procedure and continue for several days after completion to effectively prevent fungal infections 1
- This prophylactic regimen is specifically recommended by the Infectious Diseases Society of America (IDSA) guidelines for patients undergoing urologic manipulation due to increased risk of fungal dissemination 2, 1
Rationale for Prophylaxis
- Urologic procedures such as penile prosthesis insertion carry an increased risk of fungal infections, particularly candidiasis 1
- Surgical manipulation increases the risk of fungal dissemination, making antifungal prophylaxis necessary 1, 2
- Fluconazole is preferred due to its excellent bioavailability (>93%), good tissue penetration, and long half-life (22-32 hours) allowing for once-daily dosing 3, 4
Alternative Options
- For patients with contraindications to fluconazole or suspected fluconazole-resistant organisms, Amphotericin B deoxycholate at 0.3-0.6 mg/kg daily can be used for several days before and after the procedure 2, 1
- This alternative is particularly important when there is concern for resistant Candida species such as C. glabrata or C. krusei 2, 1
Clinical Considerations
- Fluconazole has demonstrated efficacy in preventing fungal infections in high-risk surgical patients 5
- The drug is well-tolerated with minimal associated toxicity compared to other antifungal agents 4, 6
- Fluconazole achieves good penetration into tissues and body fluids, with concentrations comparable to those in blood 3
- For patients with impaired renal function, dosage adjustment may be necessary as fluconazole is primarily eliminated unchanged in the urine 4
Potential Drug Interactions
- Monitor for potential interactions with other medications, particularly with agents such as cyclosporin, phenytoin, oral hypoglycemics, and warfarin 4
- Rifampin may decrease the metabolic clearance of fluconazole and should be considered when prescribing 4
By following this prophylactic regimen of fluconazole 400 mg daily starting several days before and continuing for several days after penile prosthesis surgery, the risk of fungal infections can be significantly reduced, leading to better surgical outcomes and reduced morbidity.