For empiric antifungal therapy for suspected candidemia, disseminated candidiasis in the ICU, use an echinocandin until culture data is available
Use for documented or suspected infection due to Candida species. Most non-albicans species are susceptible to fluconazole except for Candida krusei and some strains of Candida glabrata. Fluconazole resistance may increase after multiple or prolonged courses of fluconazole for treatment or prophylaxis.
| Site of Infection | Dose (1,2) | Duration of Therapy |
|---|---|---|
| Vaginal candidiasis (uncomplicated) | 150 mg | x 1 dose +/- intravaginal clotrimazole |
| Oral thrush | 100 mg daily If possible, start with nystatin swish and swallow | 7-14 days |
| Esophageal candidiasis | 200 mg daily | 14-21 days |
| UTI, not colonization | 200 mg daily | 7-14 days |
| Candidemia *mandatory ID consult | 12mg/kg IV x 1 then 6mg/kg po/IV daily *800mg/day should be used for isolates that demonstrate dose-dependent susceptibility (SDD) | 14 days (minimum) after first negative blood culture and resolution of signs and symptoms of infection (3) ALL PATIENTS WITH CANDIDEMIA NEED AN OPTHALMOLOGY CONSULT TO RULE OUT ENDOPTHALMITIS |
| Intra-abdominal infection Routine use of antifungal therapy not indicated. Consider if patient is immunosuppressed from cancer chemotherapy or transplantation, or if surgical or traumatic injury to the gut wall, or inflammatory disease | 400 mg daily | Duration of therapy not well defined; guide by patient response. Usually 2-3 weeks |
| Empiric use in the ICU (4) | 12mg/kg x 1 then 6mg/kg daily | Not defined |
| Sputum | No treatment; usually a colonizer | – |
CID 2016; 62(4):e1-50.
- Fluconazole PO is 100% bioavailable – systemic concentrations after PO are comparable to concentrations achieved after IV administration. Fluconazole is part of the Automatic Therapeutic Interchange Program at HHS.
- See renal dose adjustment table.
- Breakthrough or persistent candidemia despite continued antifungal therapy suggests possibility of an infected intravascular device, significant immunosuppression, or microbiological resistance.
- Utility of fluconazole is controversial. Empiric use may be appropriate in patients with persistent fever, hypothermia or hypotension despite 5 days of appropriate antibiotics and without another diagnosis. Patients at higher risk for candidemia include those with Candida colonization at multiple sites, absence of uncorrected causes of fever or hypotension,. prolonged use of antibacterial antibiotics, presence of central venous catheters, TPN, surgery (especially if transects the abdominal wall) and prolonged ICU stay.