Fluconazole

C difficile risk
Low
Oral Bioavailability
Excellent (90 to 100%)
Cost
$

Dosing

PNA-days 0 - 14PNA-days 14+ 12 mg/kg/dose IV/PO q48h12 mg/kg/dose IV/PO q24h

PNA-days 0 - 7PNA-days 7+ 12 mg/kg/dose IV/PO q48h12 mg/kg/dose IV/PO q24h

Consider prophylaxis only in VLBW infants at high risk for invasive fungal disease. 3 mg/kg/dose IV/PO q72h.

Severe Invasive Candidiasis (i.e., candidemia, intra-abdominal infections, osteoarticular infections, etc.)Oropharyngeal candidiasis (Thrush)Esophageal candidiasisVaginal/Vulvovaginal candidiasis- Loading Dose: 12 mg/kg (commonly 800 mg) IV/PO x 1 dose on day 1, then

  • Maintenance Dose: 6 mg/kg (commonly 400 mg) IV/PO Q24h

  • Duration: Per guidance from Infectious Diseases Antibiotic Stewardship or Consultation Service200 mg IV/PO Q24h x 7-14 days400 mg IV/PO Q24h x 14-21 days- Uncomplicated: 150 mg IV/PO once

  • Complicated or severe: 150 mg IV/PO Q72h x 2-3 doses

Includes blastomycosis, coccidioidomycosis, cryptococcosisRequires guidance from Infectious Diseases Consultation Service

IV to PO ConversionRenal Impairment- 1:1, for example:

  • 100 mg IV daily to 100 mg PO daily

  • 400 mg IV daily to to 400 mg PO daily- CrCl ≤50 mL/minute: Reduce dose by 50%

  • HD three times weekly: Keep the same dosage but administer maintenance doses 3 times a week after HD sessions

General Information

Pediatrics: I.D. authorization required

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