Fluconazole Dosage for Penile Prosthesis Prophylaxis
For patients undergoing penile prosthesis insertion, 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
Rationale and Administration Protocol
- Antifungal prophylaxis is recommended for patients undergoing urologic procedures such as penile prosthesis insertion due to the increased risk of fungal infections, particularly candidiasis 1
- The prophylactic regimen should begin several days before the procedure and continue for several days after completion to effectively prevent fungal colonization and infection 1
- This approach helps reduce the risk of prosthetic device infections, which can lead to significant morbidity and potential need for device removal 2
Specific Dosing Considerations
- The recommended dose is 400 mg (6 mg/kg) of fluconazole daily 1
- For patients with renal impairment, dose adjustment may be necessary as fluconazole is primarily eliminated through the kidneys 2
- The oral formulation is preferred for pre-procedure dosing, while intravenous administration may be used perioperatively if the patient cannot take oral medications 1
Alternative Options
- For patients with contraindications to fluconazole or at high risk of fluconazole-resistant organisms:
- Amphotericin B deoxycholate at 0.3-0.6 mg/kg daily for several days before and after the procedure 1, 2
- An echinocandin (caspofungin 50-70 mg daily, micafungin 100 mg daily, or anidulafungin 100 mg daily) may be considered for patients at risk of infection with fluconazole-resistant Candida species such as C. glabrata or C. krusei 2
Duration of Prophylaxis
- Prophylaxis should begin several days before the procedure and continue for several days after 1
- For most uncomplicated cases, a 7-10 day course (including pre- and post-procedure days) is typically sufficient 2, 1
- Longer courses may be considered for patients with additional risk factors for fungal infection 2
Monitoring and Follow-up
- Monitor for clinical signs of fungal infection post-procedure 1
- Be vigilant for potential development of resistant Candida species, particularly with prolonged use of fluconazole 1
- Assess for adverse effects of fluconazole, including elevated liver enzymes, gastrointestinal symptoms, and potential drug interactions 2
Special Considerations
- For patients with prosthetic devices that cannot be removed due to infection, chronic suppression with fluconazole 400 mg (6 mg/kg) daily is recommended if the isolate is susceptible 2
- In cases of documented infection involving a prosthetic device, device removal is generally recommended along with appropriate antifungal therapy 2
- Fluconazole has been shown to effectively prevent colonization and invasive fungal infections in high-risk surgical patients 3