Indications
Fluconazole is indicated in
- Superficial candidal infections such as oral or vaginal thrush
- Esophagitis caused by Candida or other susceptible species
- Maintenance therapy of cryptococcal meningitis
- Disseminated candidiasis
- Prophylaxis for fungal infection in neutropenic cancer patients
- Acute treatment of other systemic fungal infections
- Dermatophyte and Candida skin infections
- Fungal UTIs
Pharmacology
Fluconazole is the first of a new subclass of synthetic triazole antifungal agent which acts by inhibition of the ergosterol component of the fungal cell membrane. It is active against a broad spectrum of fungal pathogens and is available for oral use.
Dosage
Children:
- Oropharyngeal Candidiasis:Â 6 mg/kg on the first day, followed by 3 mg/kg once daily. Treatment should be administered for at least 2 weeks to decrease the likelihood of relapse.
- Esophageal Candidiasis:Â 6 mg/kg on the first day, followed by 3 mg/kg once daily.
- Cryptococcal meningitis:Â Initial therapy should be started with 6 to 12 mg/kg daily. Doses up to 12 mg/kg/day may be used for three weeks and treatment for initial therapy of cryptococcal meningitis is 10 to 12 weeks.
Intravenous-
Adult & child:Â Invasive candidal infections including candidaemia and disseminated candidiasis and cryptococcal infections including meningitis, by IV, 400 mg initially then 200 mg daily, increased if necessary to 400 mg daily, treatment continued according to response (at least 6-8 weeks for cryptococcal meningitis); Child 6-12 mg/kg daily (every 72 hours in neonate up to 2 weeks old, every 48 hours in neonate 2-4 weeks old); maximum 400 mg daily.
Prevention of relapse of cryptococcal meningitis, by IV, 100-200 mg daily.
Contraindications
Fluconazole is contraindicated to patients hypersensitive to this drug and in advanced liver disease.
Side Effects
Therapy with Fluconazole is well tolerated. The common adverse effects are nausea. abdominal pain, vomiting, diarrhoea, headache and skin rash.
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