Inside. The daily dose depends on the nature and severity of the fungal infection.
Adults, with cryptococcal meningitis and cryptococcal infections of other locations on the first day, usually prescribed 400 mg, and then continue treatment at a dose of 200-400 mg once a day. The duration of treatment for cryptococcal infections depends on the clinical efficacy, confirmed by mycological examination. The recommended duration of treatment for the initial treatment of cryptococcal meningitis is 10-12 weeks after a negative result of microbiological examination of a sample of cerebrospinal fluid. To prevent the recurrence of cryptococcal meningitis in AIDS patients, after completion of the full course of primary therapy,
fluconazole prescribe a dose of 200 mg per day for a long period of time.
When candidemia, disseminated candidiasis and other invasive candidiasis infections in the first day, the dose is usually 400 mg, and then - 200 mg per day. With insufficient clinical efficacy, the dose of the drug can be increased to 400 mg per day; with severe systemic candidiasis - it is possible to increase the dose to 800 mg per day.The duration of therapy depends on clinical effectiveness; a course of treatment sufficient for a single dose of 300-400 mg; an alternative treatment regimen is to administer 50 mg once a day for 2-4 weeks.
With onychomycosis, the recommended dose is 150 mg once a week. Treatment should continue until the replacement of the infected nail (growth of uninfected nail). To re-grow the nails on the fingers and toes, it normally takes 3-6 months and 6-12 months, respectively.
With deep endemic mycoses, it may be necessary to use the drug at a dose of 200-400 mg per day for up to 2 years. The duration of therapy is determined individually; it can be 11-24 months with coccidioidosis and 3-17 months with histoplasmosis.
Use in children, as with similar infections in adults, the duration of treatment depends on the clinical and mycological effect. In children, the drug should not be used in a daily dose that would exceed that of adults. The drug is used daily 1 time per day.
In candidiasis of mucous membranes, the recommended dose of fluconazole is 3 mg / kg per day. On the first day, a shock dose of 6 mg / kg can be administered in order to achieve a more rapid equilibrium of concentrations.
For the treatment of generalized candidiasis or cryptococcal infection, the recommended dose is 6-12 mg / kg per day, depending on the severity of the disease.
For the prevention of fungal infections in children with reduced immunity, where the risk of infection is associated with neutropenia, resulting from cytotoxic chemotherapy or radiation therapy, the drug is prescribed at 3-12 mg / kg per day, depending on the severity and duration of preservation of induced neutropenia. The maximum daily dose for children is 12 mg / kg.
Dosing for patients with renal insufficiency
Fluconazole is excreted mainly by the kidneys in unchanged form. With a single application, dose adjustment is not required.
Adult patients with impaired renal function in the course of the drug should first be prescribed a "shock dose" of 50 mg to 400 mg. If the creatinine clearance (CK) is> 50 ml / min, the usual dose of the drug (100% of the recommended dose) is used. At CC <50 ml / min, a dose equal to 50% of the recommended dose or a usual dose of 1 every 2 days is applied. Patients regularly on dialysis, a single dose of the drug is used after each session of hemodialysis.
In children with impaired renal function, the daily dose of the drug should be reduced (in the same proportional relationship as in adults), according to the degree of renal insufficiency.
In elderly patients in the absence of violations of kidney function should follow the usual dosage regimen.