Fluconazole
Neonatal

Neonatal

Documented Candidiasis or Clinicaly Suspected Invasive Candidal Infection

Note
  • For C. albicans and other species (e.g. C. tropicalis, C. parapsilosis) susceptible to fluconazole.
  • Note C. krusei, C. auris are resistant
  • Loading dose 25mg/kg could be used in selected circumstances such as severe illness, CNS infections, ECMO (considering hepatic and renal status as well as potential medication interactions).
GA 26-29 weeks

PNA 0-7 days: 12 mg/kg on day 1, and day 2 then 12mg/kg q48h

PNA >7 days: 12 mg/kg on day 1, then 12 mg/kg q24h

GA 30-40 weeks

12 mg/kg q24h

Thrush

6 mg/kg/dose q24h for 3 - 5 days

Prophylaxis for Prevention of Candidiasis

  • Preterm neonates ≥ 30 wks GA: 6mg/kg every 48h
  • Preterm <30 weeks GA: 3 or 6 mg/kg/dose IV q72 hours
  • > 42days PNA: 6 mg/kg q48 hours (decrease by 50% if creatinine is >106 umol/L)

Note

Indications for prophylaxis

Prophylactic fluconazole may be considered in infants with a high risk of invasive fungal infections such as extremely low birth weight infants (birth weight below 1000 g) with additional risk factors such as prolonged treatment with systemic broad-spectrum antibiotics.