Fluconazole: Difference between revisions
From IDWiki
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*Efficacy predicted by AUC/MIC ratio |
*Efficacy predicted by AUC/MIC ratio |
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=== Breakpoints === |
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{| class="wikitable" |
{| class="wikitable" |
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! rowspan="2" |Species |
! rowspan="2" |Species |
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! rowspan="2" |ECV (μg/mL) |
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! colspan="4" |Breakpoints (μg/mL) |
! colspan="4" |Breakpoints (μg/mL) |
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! colspan="4" |Breakpoints (mm) |
! colspan="4" |Breakpoints (mm) |
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|[[Candida albicans]] |
|[[Candida albicans]] |
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|0.5 |
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|≤2 |
|≤2 |
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|— |
|— |
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|14-16 |
|14-16 |
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|≤13 |
|≤13 |
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|[[Candida dubliniensis]] |
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|0.5 |
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|[[Candida glabrata]] |
|[[Candida glabrata]] |
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|8 |
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|— |
|— |
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|— |
|— |
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|≥15 |
|≥15 |
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|≤14 |
|≤14 |
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|[[Candida guilliermondii]] |
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|8 |
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|[[Candida krusei]] |
|[[Candida krusei]] |
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| colspan="4" |intrinsically resistant |
| colspan="4" |intrinsically resistant |
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| colspan="4" |intrinsically resistant |
| colspan="4" |intrinsically resistant |
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|[[Candida lusitaniae]] |
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|1 |
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|[[Candida parapsilosis]] |
|[[Candida parapsilosis]] |
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|1 |
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|≤2 |
|≤2 |
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|— |
|— |
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|[[Candida tropicalis]] |
|[[Candida tropicalis]] |
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|1 |
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|≤2 |
|≤2 |
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|— |
|— |
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|14-16 |
|14-16 |
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|≤13 |
|≤13 |
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|[[Cryptococcus neoformans]] |
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|8 |
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| colspan="8" rowspan="2" | |
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|[[Cryptococcus gattii]] |
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|16-32 |
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Revision as of 20:38, 21 August 2020
Background
- Antifungal in the triazole family with excellent bioavadilability but limited efficacy outside of Candida
Pharmacokinetics and Pharmacodynamics
- Good oral bioavailability
- Good CNS penetration
- Fungistatic
- Efficacy predicted by AUC/MIC ratio
Breakpoints
| Species | ECV (μg/mL) | Breakpoints (μg/mL) | Breakpoints (mm) | ||||||
|---|---|---|---|---|---|---|---|---|---|
| S | I | SDD | R | S | I | SDD | R | ||
| Candida albicans | 0.5 | ≤2 | — | 4 | ≥8 | ≥17 | — | 14-16 | ≤13 |
| Candida dubliniensis | 0.5 | ||||||||
| Candida glabrata | 8 | — | — | ≤32 | ≥64 | — | — | ≥15 | ≤14 |
| Candida guilliermondii | 8 | ||||||||
| Candida krusei | intrinsically resistant | intrinsically resistant | |||||||
| Candida lusitaniae | 1 | ||||||||
| Candida parapsilosis | 1 | ≤2 | — | 4 | ≥8 | ≥17 | — | 14-16 | ≤13 |
| Candida tropicalis | 1 | ≤2 | — | 4 | ≥8 | ≥17 | — | 14-16 | ≤13 |
| Cryptococcus neoformans | 8 | ||||||||
| Cryptococcus gattii | 16-32 | ||||||||
Monitoring
- ECG for QT prolongation
- Liver enzymes for hepatitis
Adverse Drug Reactions
- Best side effect profiles of the antifungals
- Before starting, check:
- Liver enzymes as baseline (hepatitis)
- Creatinine (requires renal dosing)
- EKG (QTc prolongation)
- Beware drug-drug interactions, especially with new DOACs
