Fluconazole / Diflucan


- Discussion:
   
- for treatment of Candida infections;
    - bioavailability of orally administered fluconazole is over 90% compared with intravenous administration
    - dose 200 to 400 mg per day

- Cautions:
    - Dosing Regimens for Patients w/ Renal Insufficiency:
              (Dose for 70 kg Adult (gm/dosing interval in hours) CrCl:>80: 0.1-0.2/24; CrCl: 50-79: 0.1-0.2/24; CrCl: 30-49: 0.05-0.1/24; CrCl:10-29: 0.025-0.05/24;
    - 80 % of dose will be excreted in urine (w/ nl R F(x))
    - Will falsely incr Serum Cr;
    - Will increase effect of warfarin;
    - Ratio of CSF to Blood Level (%): Nl Meninges: 70-80; Inflammed: > 70-80


References for Fluconazole:

   - A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. Candidemia Study Group and the National Institute. 
   - In vitro analysis of antifungal impregnated polymethylmethacrylate bone cement.
   - Successful 1-stage exchange total knee arthroplasty for fungal infection. 
   - Candida arthritis after total knee arthroplasty--a case of successful treatment without prosthesis removal
   - Candida albicans prosthetic arthritis treated with fluconazole alone.
   - Fungal arthritis--a rare complication of systemic candidiasis or orthopedic intervention. Review of therapeutic experience with fluconazole  
   - Micafungin plus fluconazole in an infected knee with retained hardware due to Candida albicans.
   - Microbiological, clinical, and surgical features of fungal prosthetic joint infections: a multi-institutional experience
   - Synovial fluid levels of fluconazole in a patient with Candida parapsilosis prosthetic joint infection who had an excellent clinical response



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, December 6, 2012 3:28 pm