Fluconazole: Difference between revisions
From IDWiki
No edit summary |
(added breakpoints table) |
||
| Line 9: | Line 9: | ||
*Fungistatic |
*Fungistatic |
||
*Efficacy predicted by AUC/MIC ratio |
*Efficacy predicted by AUC/MIC ratio |
||
*Susceptibility breakpoints for [[Candida albicans]] are: |
|||
{| class="wikitable" |
|||
**Susceptible MIC ≤2 |
|||
! rowspan="2" |Species |
|||
**Susceptible dose-dependent MIC 4 |
|||
! colspan="4" |Breakpoints (μg/mL) |
|||
**Resistant MIC ≥8 |
|||
! colspan="4" |Breakpoints (mm) |
|||
|- |
|||
!S |
|||
!I |
|||
!SDD |
|||
!R |
|||
!S |
|||
!I |
|||
!SDD |
|||
!R |
|||
|- |
|||
|[[Candida albicans]] |
|||
|≤2 |
|||
|— |
|||
|4 |
|||
|≥8 |
|||
|≥17 |
|||
|— |
|||
|14-16 |
|||
|≤13 |
|||
|- |
|||
|[[Candida glabrata]] |
|||
|— |
|||
|— |
|||
|≤32 |
|||
|≥64 |
|||
|— |
|||
|— |
|||
|≥15 |
|||
|≤14 |
|||
|- |
|||
|[[Candida krusei]] |
|||
| colspan="4" |intrinsically resistant |
|||
| colspan="4" |intrinsically resistant |
|||
|- |
|||
|[[Candida parapsilosis]] |
|||
|≤2 |
|||
|— |
|||
|4 |
|||
|≥8 |
|||
|≥17 |
|||
|— |
|||
|14-16 |
|||
|≤13 |
|||
|- |
|||
|[[Candida tropicalis]] |
|||
|≤2 |
|||
|— |
|||
|4 |
|||
|≥8 |
|||
|≥17 |
|||
|— |
|||
|14-16 |
|||
|≤13 |
|||
|} |
|||
==Monitoring== |
==Monitoring== |
||
Revision as of 20:26, 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
| Species | Breakpoints (μg/mL) | Breakpoints (mm) | ||||||
|---|---|---|---|---|---|---|---|---|
| S | I | SDD | R | S | I | SDD | R | |
| Candida albicans | ≤2 | — | 4 | ≥8 | ≥17 | — | 14-16 | ≤13 |
| Candida glabrata | — | — | ≤32 | ≥64 | — | — | ≥15 | ≤14 |
| Candida krusei | intrinsically resistant | intrinsically resistant | ||||||
| Candida parapsilosis | ≤2 | — | 4 | ≥8 | ≥17 | — | 14-16 | ≤13 |
| Candida tropicalis | ≤2 | — | 4 | ≥8 | ≥17 | — | 14-16 | ≤13 |
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
