Fluconazole (fluconazole solution 2 mg / ml) is administered by intravenous (IV) infusion, the infusion rate is 200 mg (1 vial) per hour. Doses and dosage regimens depend on nosology.
Adults
To treat disseminated candidiasis, candidiasis pneumonia, chronic generalized (granulomatous) candidiasis, candidal peritonitis, candidemia, the loading dose of Fluconazole is 400 mg on the first day of therapy, then 200 mg once a day. With insufficient clinical effectiveness, the dose of the drug can be increased to 400 mg / day. The duration of therapy depends on clinical effectiveness.
For the treatment of cryptococcosis of different locations, the loading dose of Fluconazole on the first day of therapy is 400 mg; in the following days 200 mg once a day, with insufficient clinical efficacy - 400 mg once a day. The duration of therapy for cryptococcal meningitis is at least 6-8 weeks, until a negative culture culture of the cerebrospinal fluid is obtained. To prevent the recurrence of cryptococcal meningitis in AIDS patients after completion of the full course of primary treatment
Fluconazole prescribe at a dose of 200 mg / day for a long period of time.
With deep endemic mycoses: histoplasmosis, coccidioidosis, sporotrichosis, the loading dose of Fluconazole on the first day of therapy is 400 mg; in the following days 200 mg once a day. The duration of therapy is determined individually; it can be 11-24 months with coccidiomycosis; 2-17 months with paracoccidiomycosis; 1-16 months with sporotrichosis; 3-17 months with histoplasmosis; Considering the need for long-term use of Fluconazole in these infections (up to 2 years), stepwise therapy is preferable.
For the prevention of candidiasis against the background of immunodeficiency, incl. in patients who need bone marrow transplantation, the recommended dose of Fluconazole is 50-400 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 1 time / day.
Fluconazole appoint a few days before the expected appearance of neutropenia; after increasing the number of neutrophils more than 1000 / mm3 treatment is continued for another 7 days.
With vaginal candidiasis - 150 mg once. To reduce the relapse rate, once a month, 150 mg every 4-12 months, sometimes more frequent use may be required.
For other candidiasis of mucous membranes (except for genital candidiasis), 50-100 mg 1 time / day for 14-30 days.
Children aged 1 month. under 12 years old
In children, as with similar infections in adults, the duration of treatment depends on the clinical and mycological effect. The drug is administered as an intravenous infusion once a day, the daily dose should not exceed 600 mg / day.
For the treatment of generalized candidiasis (candidemia, disseminated candidiasis, chronic generalized (granulomatous) candidiasis), the loading dose on the first day of treatment is 12 mg / kg / day, in the following days, 6 mg / kg / day is administered.
In case of cryptococcal infection, including cryptococcal meningitis, the loading dose on the first day of treatment is 12 mg / kg / day, in the following days it is administered at the rate of 6 mg / kg / day. Depending on the severity of the clinical effect, the dose can be increased to 12 mg / kg / day. The duration of therapy is 8-12 weeks.
Patients with severe oropharyngeal candidiasis,Candidiasis esophagitis and inability to take oral forms of Fluconazole are administered at a rate of 6 mg / kg - on the first day of therapy, on subsequent days 3 mg / kg / day. Duration of treatment with
oropharyngeal candidiasis - 2 weeks; with candidal esophagitis - 3 weeks, after the relief of the symptoms of infection continue to take Fluconazole for another 2 weeks.
For the prevention of fungal infections in children who are at risk of developing infection due to induced neutropenia (patients undergoing bone marrow transplantation in the face of cytostatics and radiotherapy for malignant tumors), Fluconazole dosages are 3-12 mg / kg / day, depending on the severity and duration of neutropenia. It is mandatory to monitor the picture of peripheral blood.
Newborns under 4 weeks of age
Fluconazole is used in the same doses as in older children, but it increases the interval between administration of the drug: at the age of 0 to 2 weeks, life is injected every 72 hours, from 2 to 4 weeks of life every 48 hours.
Elderly patients
In the absence of violations of the kidneys should follow the usual dosage regimen.If renal function is impaired (creatinine clearance less than 50 ml / min), dosage adjustment is necessary in accordance with the creatinine clearance rates (see table).
The use of fluconazole in cases of impaired renal function
At course treatment the first (shock) dose is from 50 to 400 mg; in children - the calculation is made per kg of body weight. Then the dose of the drug or the frequency of administration (interdose interval) should be changed depending on the creatinine clearance, namely (see table):
| Creatinine clearance, ml / min | Dosage |
| >50 |
| The dose of the drug does not change |
| 11-50 |
| every 48 hours the usual daily dose or every 24 hours half the usual daily dose |
| When | regularly | the usual daily dose after each procedure |
| conducted hemodialysis |
|
Do not use Fluconazole as an infusion medium for the administration of other medications.