From the Guidelines
Fluconazole is primarily used to treat various forms of candidiasis, including oropharyngeal, esophageal, vaginal, and urinary tract infections, as well as invasive candidiasis and CNS infections.
Key Uses of Fluconazole
- Treatment of mucosal and invasive candidiasis: Fluconazole has demonstrated efficacy comparable to that of AmB deoxycholate for the treatment of candidemia and is considered standard therapy for oropharyngeal, esophageal, and vaginal candidiasis, as well as urinary tract infections 1, 2.
- CNS and intraocular infections: Fluconazole has the greatest penetration into the cerebrospinal fluid (CSF) and vitreous, achieving concentrations of >70% of those in serum, making it a preferred treatment option for CNS and intraocular Candida infections 1.
- Urinary tract infections: Fluconazole achieves urine concentrations that are 10–20 times the concentrations in serum, making it an effective treatment option for symptomatic cystitis 1.
Dosage and Administration
- Loading dose: 800 mg (12 mg/kg) for patients with invasive candidiasis, followed by a daily dose of 400 mg (6 mg/kg) 1, 2.
- Dose reduction: Needed in patients with creatinine clearance <50 mL/minute due to renal elimination of the drug 1, 2.
Clinical Considerations
- Resistance and susceptibility: Fluconazole has less activity against C. glabrata and C. krusei, and its use may lead to the development of resistance in these species 1, 2.
- Drug interactions: Fluconazole inhibits cytochrome P450 enzymes, which can affect the metabolism of other drugs, and its use requires careful consideration of potential interactions 1, 2.
From the FDA Drug Label
Fluconazole tablets are indicated for the treatment of: Vaginal candidiasis (vaginal yeast infections due to Candida). Oropharyngeal and esophageal candidiasis In open noncomparative studies of relatively small numbers of patients, fluconazole tablets were also effective for the treatment of Candida urinary tract infections, peritonitis, and systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia. Cryptococcal meningitis Fluconazole tablets are also indicated to decrease the incidence of candidiasis in patients undergoing bone marrow transplantation who receive cytotoxic chemotherapy and/or radiation therapy.
The use of Fluconazole is for the treatment of various fungal infections, including:
- Vaginal candidiasis
- Oropharyngeal and esophageal candidiasis
- Candida urinary tract infections
- Peritonitis
- Systemic Candida infections
- Cryptococcal meningitis It is also used for prophylaxis to decrease the incidence of candidiasis in patients undergoing bone marrow transplantation 3
From the Research
Uses of Fluconazole
- Fluconazole is used to treat various fungal infections, including: + Oropharyngeal and esophageal candidiasis 4, 5, 6, 7, 8 + Cryptococcal meningitis 4, 5, 6, 8 + Vaginal candidiasis 5, 7, 8 + Systemic mycoses, such as coccidioidosis and histoplasmosis 5, 6
- Fluconazole is also used as a prophylactic treatment to prevent fungal infections in patients with impaired immunity, such as those with AIDS or receiving cytotoxic cancer therapy 8
Administration and Dosage
- Fluconazole can be administered orally or intravenously 4, 5, 6
- The recommended dosage of fluconazole varies depending on the type and severity of the infection, as well as the patient's renal function 4, 5, 6, 7
- A single oral dose of 150 mg is often used to treat vaginal candidiasis 7
- Dosage reduction is advised for patients with impaired renal function 6
Efficacy and Safety
- Fluconazole has been shown to be effective in treating various fungal infections, with clinical efficacy rates ranging from 50 to 99% 4, 5, 6, 7, 8
- Fluconazole is generally well tolerated, with gastrointestinal symptoms being the most common adverse events 5, 7
- However, fluconazole can interact with other medications, such as cyclosporin, phenytoin, and warfarin, and can cause hepatotoxicity and exfoliative skin reactions in rare cases 4, 5, 6