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Adults and children over 15 years of age (body weight over 50 kg) with cryptococcal meningitis and cryptococcal infections of other locations on the first day are usually prescribed 400 mg (8 capsules of 50 mg), and then continue treatment at a dose of 200 mg (4 capsules of 50 mg ) - 400 mg (8 capsules of 50 mg) once a day. The duration of treatment for cryptococcal infections depends on the clinical efficacy, confirmed by mycological examination; when cryptococcal meningitis treatment course should be at least 6-8 weeks.
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 (4 capsules of 50 mg) per day for a long period of time.
When candidemia, disseminated candidiasis and other invasive candidiasis infections on the first day of the dose is 400 mg (8 capsules of 50 mg), and then - 200 mg (4 capsules of 50 mg) per day. With insufficient clinical effectiveness, the dose of the drug can be increased to 400 mg (8 capsules 50 mg) per day. The duration of therapy depends on clinical effectiveness.
With oropharyngeal candidiasis, the drug is usually prescribed for 150 mg 1 time / day; the duration of treatment is 7-14 days.If necessary, in patients with a marked decrease in immunity, treatment may be longer. -
To prevent the recurrence of oropharyngeal candidiasis in AIDS patients after completing the full course of primary therapy - 150 mg once a week.
With atrophic oral candidiasis associated with the wearing of dentures, 50 mg once a day for 14 days in combination with local antiseptic medicines to treat the prosthesis.
For other candidiasis localizations (with the exception of genital candidiasis), for example, with esophagitis, non-invasive bronchopulmonary disease, candiduria, candidiasis of the skin and mucous membranes, etc., the effective dose is usually 150 mg / day with a treatment duration of 14-30 days.
With vaginal candidiasis
fluconazole taken once inside the dose of 150 mg. To reduce the frequency of recurrences of vaginal candidiasis, the drug can be used at a dose of 150 mg once a month. The duration of therapy is determined individually;
it varies from 4 to 12 months. Some patients may need more frequent use.
With balapitis caused by Candida,
fluconazole is administered orally once a day at a dose of 150 mg per day.
For the prevention of candidiasis, the recommended dose is 50-400 mg once a day, depending on the degree of risk of fungal infection. For the prevention of candidiasis in patients with malignant neoplasms the recommended dose of fluconazole is 150-400 mg 1 time / day, depending on the degree of risk of fungal infection. If there is a high risk of generalized infection, for example, in patients with expected severe or persistent neutropenia, the recommended dose is 400 mg / day.
Fluconazole appoint a few days before the expected appearance of neutropenia; after the increase in the number of neutrophils more than 1 thousand / μl treatment is continued for another 7 days.
With mycosis of the skin, including mycosis of the feet, skin of the inguinal region, and skin candidiasis, the recommended dose is 150 mg once a week or 50 mg once a day, the dosage regimen depends on the clinical and mycological effect. Duration of therapy in usual cases is 2-4 weeks, however, with foot mycoses, longer therapy (up to 6 weeks) may be required.
With pityriasis - 300 mg (2 capsules of 150 mg) once a week for 2 weeks, some patients require a third dose of 300 mg per week,while in some cases it is sufficient to receive 300-400 mg once; an alternative treatment regimen is to apply 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 (the growth of the uninfected nail). For the repeated growth of the nails on the fingers and toes 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 mg (4 capsules of 50 mg) - 400 mg (8 capsules 50 mg) per day for up to 2 years. The duration of therapy is determined individually; it can be 11-24 months with coccidioidomycosis: 2-17 months. with paracoccidioidomycosis: 1-16 months. with sporotrichosis and 3-17 months. with histoplasmosis.
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 in adults, i.e. not more than 400 mg per day. The drug is used daily 1 time / day.
Application of Fluconazole 50 mg capsules in children from 4 to 15 years of age
| Diseases | Weight and weight of the child |
|
| 4-6 years the average weight of the child is 15-20 kg | 7-9 years old child's average weight 21-29 kg | 10-12 years the average weight of the child is 30-40 kg | 12-15 years old the average child weight is 40-50 kg |
| Candidiasis of the esophagus (3 mg / kg/ cvm) | 1 capsule 50 mg per day | 1-2 capsules 50 mg per day | 2 capsules of 50 mg once | 2-3 capsules of 50 mg once |
| Treatment period | For at least 3 weeks and within 2 weeks after regression of symptoms. |
| Candidiasis of mucous membranes (3 mg / kg/ cvm) | On the 1st day: 2-3 capsules Next: 1 capsule per day | In the 1st day: 2-4 capsules Next: 1-2 capsules per day | On the 1st day: 4-5 capsules Further: 2 capsules per day once | On the 1st day: 5-6 capsules Next: 2-3 capsules per day once |
| Treatment period | On the first day, a shock dose is given in order to achieve a more rapid steady-state equilibrium concentration, then the treatment is continued for at least 3 weeks. |
| Generalized candidiasis and cryptococcal infection (including meningitis) 6-12 mg / kg / day | 2-5 capsules per day | 2-6 capsules per day | 4-7 capsules per day | 5-8 capsules per day |
| Treatment period | Within 10-12 weeks (before laboratory confirmation of absence of pathogens in CSF) |
| Prevention of fungal infections in children with reduced immunity,at which the risk of infection is associated with neutropenia, resulting from cytotoxic chemotherapy or radiotherapy PZ-12 mg / kg / day | 1-5 capsules per day | 1-6 capsules per day | 2-7 capsules per day | 2-8 capsules per day |
| Treatment period | The drug is given in doses, depending on the severity and duration of preservation of induced neutropenia. |
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. Patients with renal insufficiency (creatinine clearance less than 50 ml / min) dosage regimen should be adjusted as indicated below.
Fluconazole is excreted mainly with urine in unchanged form. In chronic renal failure, a "shock" dose of 50-400 mg is initially administered. If the clearance of creatinine (CC) is more than 50 ml / min, the usual dose of the drug (100% of the recommended dose) is used. With SC from 11 to 50 ml / min 50% of the recommended dose or usual dose is applied once every 2 days.
In patients with impaired renal function, the drug is used according to the following scheme:
| Creatinine clearance | Interval / daily dose |
> 40 ml / min 21-40 ml / min 10-20 ml / min | 24 hours (normal dosing regimen) 48 hours (1 time in 2 days) or half the usual daily dose (1 time in 24 hours) 72 hours (1 every 3 days) or a third of the usual daily dose (1/3 in 24 hours) |
Patients regularly on dialysis, one dose of the drug is used after each session of hemodialysis.