Spectrum: Local Antimicrobial Stewardship, for Prisma Health Children’s Hospital-Midlands

Fluconazole

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

IV$$$ PO$$

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

Dosing

Pediatric

Neonatal

PNA ≤ 14 days6 mg/kg, IV, q72hr. Infuse over 2 hours

PNA 15-30 days6 mg/kg, IV, q48hr. Infuse over 2 hours

Renal

Renally cleared, requires dosage adjustment with changes in renal function. Consult a pharmacist for renal dosing

Other

Daily dose of fluconazole is the same for oral and IV administration unless otherwise specified

General Information

Common Usage

Common Usage

Candida infections both mucocutaneous and invasive - i.e. Candidemia

Cryptococcus and Coccidioides infections

Antifungal prophylaxis in immunocompromised

Drug Monitoring

Drug Monitoring

Consider QTc monitoring if concomitant drugs affecting the interval or elevated baseline measurement

Adverse Effects

Adverse Effects

  • QTc prolongation

  • Hepatic enzyme abnormalities

  • Rash

  • GI upset

Major Interactions

Major Interactions

Many via CYP450 - suggest review interactions with pharmacist

Risk when combining with other QTc prolonging medications

Pharmacology

Pharmacology

Antimicrobial class: Triazole antifungal

Average serum half life:

  • Premature neonates: 47-73.6 hours.

  • Pediatrics (9 months to 15 years): oral 19.5-25 hours

  • 5- 15 years: IV 15-18 hours

  • Adults: Normal renal function: ~30 hours

Route of Elimination: 80% unchanged in urine; 11% metabolites in urine.