Fluconazole

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

IV-$15/d PO-$3/d

Spectrum Of Activity

Dosing

Loading dose: IV 12-25mg/kg/DOSE, followed by
Maintenance dose: IV 6- 12mg/kg/DOSE q24h or at the suggested intervals:

  • PNA 0-14 days: 48 hours.

  • PNA more than 14 days: 24hours.

Loading dose: IV 12-25mg/kg/DOSE, followed by
Maintenance dose: IV 6- 12mg/kg/DOSE q24h or at the suggested intervals:

  • PNA 0-7 days: 48 hours

  • PNA more than 7 days: 24 hours.

Consider prophylaxis only in VLBW infants at high risk for invasive fungal disease.
IV: 3 to 6 mg/kg/DOSE administered twice weekly. Doses vary based on indication.

Daily dose of fluconazole is the same for oral and IV administration unless otherwise specified.

Up to 12 mg/kg/DAY given as a single daily dose for serious infections and candidemia

3-6 mg/kg/DAY given as a single daily dose

Renally cleared, requires dosage adjustment with changes in renal function. Consult a pharmacist for renal dosing.

General Information

Drug Monitoring

Consider QTc monitoring if concomitant drugs affecting the interval or elevated baseline measurement

Adverse Effects

  • QTc prolongation

  • Hepatic enzyme abnormalities

  • Rash

  • GI upset

Major Interactions

Many via CYP450 - suggest review interactions with pharmacist.

Risk when combining with other QTc prolonging medications

Pharmacology

Antimicrobial class: Triazole antifungal

Average serum half life:

  • Premature neonates: 47-73.6 hours.

  • Pediatrics (9 months to 15 years): oral 19.5-25 hours

  • 5- 15 years: IV 15-18 hours

  • Adults: Normal renal function: ~30 hours

Route of Elimination: 80% unchanged in urine; 11% metabolites in urine.

Common Usage

  • Candida infections both mucocutaneous and invasive - i.e. Candidemia

  • Cryptococcus and Coccidioides infections

  • Antifungal prophylaxis in immunocompromised