Inside. The daily dose depends on the nature and severity of the fungal infection.
Adults with cryptococcal meningitis and cryptococcal infections at other sites on the first day is usually administered 400 mg and the treatment is then continued at a dose of 200 mg 1 time per day.Depending on the answer, the dose can be increased to 400 mg once a day. The duration of treatment for cryptococcal infections depends on the clinical efficacy, confirmed by mycological examination. The recommended duration of treatment for the initial treatment of cryptococcal meningitis is 10-12 weeks after a negative result of a microbiological study of a sample of cerebrospinal fluid.
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 per day for a long period of time.
When candidemia, disseminated candidiasis and other invasive candidiasis infections in the first day, the dose is usually 400 mg, and then - 200 mg per day. With insufficient clinical efficacy, the dose of the drug can be increased to 400 mg per day; with severe systemic candidiasis - it is possible to increase the dose to 800 mg per day. The duration of therapy depends on clinical effectiveness; treatment should be continued at least 2 weeks after receiving negative blood cultures or after the disappearance of the symptoms of the disease.
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 (3 weeks).
In atrophic candidiasis of the oral cavity associated with the wearing of dentures, fluconazole is usually prescribed 50 mg once a day for 14 days in combination with 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; with severe candidiasis of the mucous membranes - 100-200 mg per day. 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, Ciskan® is taken once inside at a 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 spp., Ciskan® 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. 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 daily. Ciskan® is prescribed 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 candidiasis), including mycosis of the feet, skin of the inguinal area, 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 it is sufficient to receive 300-400 mg once; 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). To re-grow 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 at a dose of 200 to 400 mg per day for up to 2 years. The duration of therapy is determined individually; it can be 11-24 months with coccidioidosis 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 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 can be administered to achieve equilibrium concentrations more quickly.
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 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 per day, depending on the severity and duration of preservation of induced neutropenia. The maximum daily dose for children is 12 mg / kg.
Dosing for patients with renal insufficiency
Fluconazole is excreted mainly by the kidneys in unchanged form. With a single admission, a dose change is not required.
Adult patients with impaired renal function with a repeated prescription of the drug should first be prescribed 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 or a usual dose of 1 every 2 days is applied. Patients regularly on dialysis, a single dose of the drug is used after each session of hemodialysis.
Children with impaired renal function the daily dose should be reduced (in the same proportion as in adults), in accordance with the severity of renal failure.
In elderly patients in the absence of violations of kidney function should follow the usual dosage regimen.