Intravenously drip at a rate of not more than 200 mg / h. The daily dose of fluconazole depends on the nature and severity of the fungal infection. When transferring from intravenous administration to taking tablets and vice versa, there is no need to change the daily dose.
Solution for infusion is compatible with 20% glucose solution, Ringer's solution, Hartman's solution, potassium chloride solution in glucose, 4.2% sodium bicarbonate solution, 0.9% sodium chloride solution. Infusions can be performed with conventional transfusion kits using one of the above solvents.
Treatment can begin before the results of sowing and other laboratory studies. However, therapy needs to be changed accordingly when the results of these studies become known.
Adults
In cryptococcal meningitis and cryptococcal infections of other localizations, on the first day 400 mg of fluconazole are prescribed on average, 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; with cryptococcal meningitis, it usually lasts a minimum of 6-8 weeks.
To prevent the recurrence of cryptococcal meningitis in AIDS patients, after completion of a full course of primary treatment, fluconazole therapy at a dose of 200 mg / day can be continued for a very long time (transition to an oral form is possible).
With candidemia, disseminated candidiasis and other invasive candidiasis infections, the dose is, on average, 400 mg on the first day, and then at 200 mg per day. With insufficient clinical efficacy, the dose of fluconazole can be increased to 400 mg / day. The duration of therapy depends on clinical effectiveness.
For the prevention of candidiasis in the presence of a high risk of generalized infection, for example in patients with severe or long-lasting neutropenia, the recommended dose is 400 mg 1 time / day.
Fluconazole appoint a few days before the expected appearance of neutropenia and after an increase in the number of neutrophils more than 1000 / μL treatment is continued for another 7 days.
With deep endemic mycoses, it may be necessary to use the drug in a dose of 200-400 mg / day for up to 2 years. The duration of therapy is determined individually; when it is coccidioidomycosis - 11-24 months, with paracoccidioidomycosis - 2-17 months, with sporotrichosis - 1-16 months and histoplasmosis - 3-17 months (a transition to an oral form).
In Asti, 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, that is, not more than 400 mg per day. The drug is used daily 1 time / day. If it is necessary to carry out long-term therapy, it is possible to switch to the oral form of fluconazole.
In cryptococcal meningitis and cryptococcal infections of other localizations, as well as in generalized candidiasis in children, the recommended dose is 6-12 mg / kg / day, depending on the severity of the disease. Duration of therapy - for 10-12 weeks (before laboratory confirmation of the absence of pathogens in the cerebrospinal fluid).
To prevent the recurrence of cryptococcal meningitis in children with SML, after completion of the full course of primary treatment, fluconazole therapy at a dose of 6 mg / kg / day can be continued for a long time.
With oropharyngeal candidiasis in children, the recommended dose is 6 mg / kg on the first day, then daily at 3 mg / kg / day, once. Duration of therapy - for at least 2 weeks.
When candidiasis of mucous membranes in children the recommended dose of fluconazole is 3 mg / kg / day. On the first day, a shock dose of 6 mg / kg may be prescribed to achieve a more rapid equilibrium equilibrium concentration. The duration of therapy is at least 3 weeks.
When candidiasis of the esophagus in children
fluconazole is prescribed once in a daily dose of 3 mg / kg. On the first day, a shock dose of 6 mg / kg / day can be prescribed. Depending on the severity of the disease, the dose can be increased to 6-12 mg / kg / day. The duration of therapy is at least 3 weeks and 2 weeks after regression of the symptoms.
For the prevention of fungal infections in children with reduced immunity, at which the risk of infection is associated with neutropenia, resulting from cytotoxic chemotherapy or radiation therapy,
fluconazole is prescribed once in a daily dose of 3-12 mg / kg / day. The duration of therapy is until elimination of induced neutropenia.
When using the drug in children aged from the newborn period to 4 weeks
it should be borne in mind that in newborns
fluconazole output slowly. In the first 2 weeks of life, the drug is administered at the same dose (in mg / kg) as for older children, but at an interval of 72 hours. Children aged 4 weeks are administered the same dose at intervals of 48 hours.
Application in the elderly.
In the absence of violations of the kidneys should follow the usual dosage regimen. Freestanding with renal failure (creatinine clearance less than 50 ml / min), the dosage regimen should be adjusted as indicated below.
Use of the drug in patients with impaired renal function.
At QC less than 50 ml / min, the dosage regimen is required.
Fluconazole is excreted mainly with urine in unchanged form. With a single admission, a dose change is not required. In patients with impaired renal function with repeated use of the drug, a shock dose of 50 mg to 400 mg should be initially administered, after which the daily dose (depending on the indications) is determined according to the following table.
| Creatinine clearance (ml / min) | Percent recommended dose |
| >50 | 100% |
| <50 (without dialysis) | 50% |
| Patients permanently on dialysis | 100% after each dialysis session |
Fluconazole is administered intravenously drip at a rate of no more than 200 mg / hour. When transferring a patient from intravenous administration to taking the drug inside or vice versa, a daily dose change is not required.
In children with impaired renal function, the daily dose of the drug should be reduced (in the same proportion as in adults), in accordance with the degree of renal insufficiency.
The drug solution contains 0.9% sodium chloride solution; in each 100 ml bottle contains 15 mmoles of Na + and Cl, therefore, in patients who require a restriction of sodium or liquid intake, the rate of fluid administration must be considered.