Fluconazole

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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