From the Guidelines
Fluconazole is recommended at a dose of 800 mg (12 mg/kg) as a loading dose, followed by 400 mg (6 mg/kg) daily for treating fungal sepsis.
Key Points
- The dosage is based on the clinical practice guidelines for the management of candidiasis by the Infectious Diseases Society of America, as outlined in the 2016 update 1.
- This recommendation applies to patients who have had no recent azole exposure and are not colonized with azole-resistant Candida species.
- The use of fluconazole as an alternative to echinocandins is supported by moderate-quality evidence 1.
- The 2009 guidelines also support the use of fluconazole at a similar dose, with a loading dose of 800 mg (12 mg/kg) and a maintenance dose of 400 mg (6 mg/kg) daily 1.
Considerations
- The choice of antifungal therapy should be based on clinical assessment of risk factors, surrogate markers for invasive candidiasis, and/or culture data from nonsterile sites.
- Echinocandins are preferred for empiric therapy in nonneutropenic patients in the ICU, but fluconazole is an acceptable alternative in certain cases.
- The recommended duration of empiric therapy for suspected invasive candidiasis is 2 weeks, but this may be adjusted based on individual patient response and clinical circumstances.
From the FDA Drug Label
Systemic Candida infections: For the treatment of candidemia and disseminated Candida infections, daily doses of 6 to 12 mg/kg/day have been used in an open, noncomparative study of a small number of children
The appropriate Fluconazole dose for treating fungal sepsis, which can be considered similar to systemic Candida infections, is 6 to 12 mg/kg/day. This dose is based on the treatment of candidemia and disseminated Candida infections in children, as no specific dose for fungal sepsis is provided in the label 2.
From the Research
Fluconazole Dosing for Fungal Sepsis
- The appropriate dose of fluconazole for treating fungal sepsis is not explicitly stated in the provided studies, but one study 3 used a daily dose of 200 mg of fluconazole in patients with septic shock.
- This study found that fluconazole was effective in reducing mortality and organ failure in patients with septic shock, particularly those with intra-abdominal sepsis.
- Other studies 4, 5, 6 used various doses of fluconazole for treating fungal infections, including 100-400 mg/day for oropharyngeal candidiasis 4, 50 mg/day for prophylaxis in neutropenic patients 5, and 100-200 mg/day for cutaneous candidosis, oropharyngeal candidosis, and vulvovaginal candidosis 6.
- However, these studies did not specifically address the treatment of fungal sepsis, and the optimal dose for this condition is not clearly established.
- One study 6 mentioned that higher doses of up to 800 mg/day may be required in severe cases of fungal infections, but this was not specifically related to fungal sepsis.