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Adults with cryptococcal meningitis and cryptococcal infections of other localization 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; in cryptococcal meningitis, it is usually continued 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.
When candidemia is disseminated candidiasis and other invasive candidiasis infections, the dose is usually 400 mg on the first day, and then 200 mg. With insufficient clinical efficacy, 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 50-100 mg once a day; the duration of treatment is 7-14 days. If necessary, in patients with a marked decrease in immunity, treatment may be longer.
With atrophic candidiasis of the oral cavity, associated with the wearing of dentures, fluconazole usually prescribed 50 mg once a day for 14 days in combination with local antiseptic agents for prosthesis treatment.
With other localizations of candidiasis (with the exception of genital candidiasis), for example, with esophagitis, noninvasive bronchopulmonary disease, candiduria, candidiasis of the skin and mucous membranes, etc. the effective dose is usually 50-100 mg per day with a treatment duration of 14-30 days. To prevent the recurrence of oropharyngealcandidiasis in patients with AIDS after completing a full course of primary therapy, the drug can be administered at 150 mg once a week.
With vaginal candidiasis fluconazole taken once inside the dose of 150 mg. To reduce the frequency of recurrence 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 once a 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, once a 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 skin mycoses, including foot mycoses, inguinal skin and skin candidiasis, the recommended dose is 150 mg once a week or 50 mg once a day.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 once a week for 2 weeks. Some patients require a third dose of 300 mg per week, while in some cases a single dose of 300-400 mg is sufficient; 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): For repeated growth of 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 in 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 coccidiomycosis; 2-17 months with paracoccidiosis; 1-16 months with sporotrichosis and 3-17 months with histoplasmosis.
In children from 3 years old, 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 may be prescribed to achieve a more rapid equilibrium equilibrium concentration.
For 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 immunocompromised, in whom the risk of infections associated with neutropenia that develops as a result of cytotoxic chemotherapy or radiation therapy, the drug is prescribed for 3-12 mg / kg per day, depending on the severity and duration of preservation-induced neutropenia. The maximum daily dose of 400 mg per day should not be exceeded in children.
In children with impaired renal function, the daily dose of the drug should be reduced (in the same proportional relationship as in adults), in accordance with the degree of renal failure.
In elderly patients, in the absence of impaired renal function, the usual dosage regimen should be followed.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 the 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.