Fluconazole

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
• Susceptibility breakpoints for Candida albicans are:
  • Susceptible MIC ≤2
  • Susceptible dose-dependent MIC 4
  • Resistant MIC ≥8

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