Fluconazole Administration During Feeding
Yes, fluconazole can be safely administered to infants and young children during or around feeding times, as the drug can be taken with or without food according to FDA labeling. 1
Administration Flexibility
- Fluconazole tablets and oral suspension can be administered with or without food, providing complete flexibility in timing relative to feeds. 1
- The bioavailability of oral fluconazole in infants is excellent and comparable to intravenous administration, with no food interaction concerns. 2
- Oral fluconazole is well absorbed and tolerated in premature infants, making it a practical alternative to IV therapy regardless of feeding schedule. 2
Practical Considerations for Infant Dosing
- For neonates in the first 2 weeks of life, administer the same mg/kg dose as older children but only every 72 hours due to prolonged half-life (55-90 hours vs. 30 hours in adults). 3, 1
- Between weeks 2-4 of life, dose every 48 hours, then transition to daily dosing after the first month. 4
- For children over 1 year with life-threatening infections, fluconazole should be administered at 6 mg/kg every 12 hours due to more rapid clearance (half-life ~14 hours). 3
Safety Profile in Pediatric Population
- Fluconazole was well tolerated in 562 children aged 0-17 years, with only 10.3% reporting treatment-related side effects, most commonly gastrointestinal (7.7%). 5
- Only 3.2% of pediatric patients discontinued treatment due to side effects, primarily gastrointestinal symptoms. 5
- In 24 neonates and infants (aged 2 days to 10 months), adverse events occurred in only 8% and did not require discontinuation. 6
Breastfeeding Context
- The Infectious Diseases Society of America (IDSA) and American Academy of Pediatrics confirm that breastfeeding mothers can safely continue nursing while taking fluconazole without interruption. 7
- Fluconazole is present in breast milk at levels less than the neonatal therapeutic dosage, with the estimated infant exposure being only 13% of the recommended pediatric maintenance dose. 1
- A survey of 96 breastfeeding women treated with fluconazole 150 mg every other day reported no serious adverse reactions in infants. 1
Common Pitfall to Avoid
- Never confuse prophylaxis dosing (3-6 mg/kg twice weekly) with treatment dosing - prophylaxis regimens are inadequate for active fungal infections requiring 6-12 mg/kg daily. 8