Fluconazole: Difference between revisions

From IDWiki
(Imported from text file)
 
 
(11 intermediate revisions by the same user not shown)
Line 1: Line 1:
  +
==Background==
−
= Fluconazole =
  
   
  +
*Antifungal in the triazole family with excellent bioavadilability but limited efficacy outside of ''Candida''
−
== Classification ==
  
   
  +
===Pharmacokinetics and Pharmacodynamics===
−
* Antifungal in the triazole family with excellent bioavadilability but limited efficacy outside of ''Candida''
  
   
  +
*Good oral bioavailability
−
== Indications ==
  
  +
*Good CNS penetration
  +
*Fungistatic
  +
*Efficacy predicted by AUC/MIC ratio
   
  +
===Clinical Breakpoints===
−
* Fungal infections
  
  +
{| class="wikitable"
  +
! rowspan="2" |Species
  +
! rowspan="2" |ECV (μg/mL)
  +
! colspan="4" |Breakpoints (μg/mL)
  +
! colspan="4" |Breakpoints (mm)
  +
|-
  +
!S
  +
!SDD
  +
!I
  +
!R
  +
!S
  +
!SDD
  +
!I
  +
!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]]
  +
|
  +
| colspan="4" |intrinsically resistant
  +
| colspan="4" |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
  +
| colspan="8" rowspan="2" |
  +
|-
  +
|[[Cryptococcus gattii]]
  +
|16-32
  +
|}
   
−
== Monitoring ==
 +
== Dosing ==
   
  +
* Invasive candidiasis: fluconazole 6 to 12 mg/kg PO/IV q24h
−
* ECG for QT prolongation
  
  +
*[[Candidemia]]: 12 mg/kg IV load followed by 6 mg/kg PO/IV daily
−
* Liver enzymes for hepatitis
  
  +
**Can use 800 mg daily for isolates that show dose-dependent susceptibility
  +
*[[Vaginal candidiasis]]: 150 mg PO once, with or without intravaginal [[clotrimazole]]
  +
*[[Oral thrush]]: 100 mg po daily for 7 to 14 days
  +
*[[Esophageal candidiasis]]: 200 mg PO daily for 14 to 21 days
  +
*[[Urinary tract infection]]: 200 mg po daily for 7 to 14 days
  +
*[[Intra-abdominal infections|Intraabdominal infection]]: 400 mg PO daily
   
  +
===Monitoring===
−
== Pharmacokinetics ==
  
   
  +
*ECG for QT prolongation
−
* Good oral bioavailability
  
  +
*Liver enzymes for hepatitis
−
* CNS penetration
  
   
  +
==Adverse Drug Reactions==
−
== Side Effects ==
  
   
−
* Best side effect profiles of the antifungals
 +
*Best side effect profiles of the antifungals
−
* Before starting, check:
 +
*Before starting, check:
−
** Liver enzymes as baseline
 +
**Liver enzymes as baseline ([[Adverse drug reaction::hepatitis]])
−
** Creatinine (requires renal dosing)
 +
**Creatinine (requires renal dosing)
−
** EKG (QT prolongation)
 +
**EKG ([[Adverse drug reaction::QTc prolongation]])
−
* Beware drug-drug interactions, especially with new DOACs
 +
*Beware [[Adverse drug reaction::drug-drug interactions]], especially with new DOACs
  +
  +
[[Category:Triazoles]]

Latest revision as of 19:25, 12 November 2021

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

Clinical Breakpoints

Species ECV (μg/mL) Breakpoints (μg/mL) Breakpoints (mm)
S SDD I R S SDD I 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

Dosing

Monitoring

  • ECG for QT prolongation
  • Liver enzymes for hepatitis

Adverse Drug Reactions

Retrieved from "https://idwiki.org/index.php?title=Fluconazole&oldid=8177"
Powered by MediaWiki
Powered by Semantic MediaWiki