Fluconazole - Renal Dosing

In the setting of rapidly improving/worsening renal function, calculations of eGFR are inaccurate, and dosing should be based on estimated renal function instead.

If worsening renal function, actual GFR is likely lower than calculated.

If improving renal function, actual GFR is likely higher than calculated eGFR.

0 - 30 eGFR

100 - 200mg IV/PO q24h (higher doses may be required for severe infections)

30 - 50 eGFR

100 - 200mg IV/PO q24h (400 mg IV/PO q24h for invasive infections)

50+ eGFR

No dose adjustment required

Increase dosing interval in neonates with impaired renal function

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