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In cryptococcal meningitis and cryptococcal infections of other locations, 400 mg are usually prescribed on the first day, and then continue treatment at a dose of 200-400 mg once / day.Duration. treatment for cryptococcal infections depends on the clinical efficacy, confirmed by mycological examination; in cryptococcal meningitis, it usually lasts at least 6-8 weeks. To prevent the recurrence of cryptococcal meningitis in AIDS patients, after completing the full course of primary treatment,
fluconazole prescribe at a dose of 200 mg / day for a long period of time.
With candidemia, disseminated candidiasis and other invasive candidiasis infections, the dose is usually 400 mg on the first day, and then on 200 mg. With insufficient clinical effectiveness, the dose of the drug can be increased to 400 mg / day. The duration of therapy depends on clinical effectiveness.
With oropharyngeal candidiasis, the drug is usually prescribed at 50-100 mg 1 time / day; the duration of treatment is 7-14 days. If necessary, in patients with marked, decreased immunity, treatment may be longer.
With atrophic candidiasis of the oral cavity, associated with the wearing of dentures,
fluconazole usually prescribed 50 mg 1 time / day for 14 days in combination with local antiseptic agents for prosthesis treatment.
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 50-100 mg / day with a treatment duration of 14-30 days . To prevent the recurrence of oropharyngeal candidiasis in AIDS patients after completing the full course of primary therapy, the drug can be prescribed 150 mg once a week.
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 balanitis caused by Candida,
fluconazole appoint a single dose of 150 mg orally.
For the prevention of candidiasis, 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 / mm 3, treatment is continued for another 7 days.
With mycosis of the skin, including mycosis of the feet, skin of the inguinal area, and candidiasis: from the skin, the recommended dose is 150 mg once a week or 50 mg 1 time / day. The duration of therapy in usual cases is 2-4 weeks, however, with foot mycoses may require longer therapy (up to 6 weeks).
With pityriasis, the recommended dose is 300 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 daily. An alternative treatment regimen is the use of the drug at 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). For the repeated growth of nails on the fingers and toes normally it 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 / day for up to 2 years.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 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 of adults. The drug is used daily 1 time / day.
In mucosal candidiasis, the recommended dose of fluconazole is 3 mg / kg / day. The first day can be: a shock dose of 6 mg / kg is prescribed in order to achieve a more rapid equilibrium equilibrium concentration.
For treatment of generalized candidiasis or cryptococcal infection, the recommended dose is 6-12 mg / kg / 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 / day, 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.
Use of the drug in patients with impaired renal function.
Fluconazole is excreted mainly with urine in unchanged form. With a single admission, a dose change is not required. When re-administering the drug, patients with impaired renal function should first introduce a shock dose of 50 mg to 400 mg. If the creatinine clearance (CK) 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, a dose equal to 50% of the recommended dose is applied. Patients regularly on dialysis, one dose of the drug is used after each session of hemodialysis.