Fluconazole Dosage

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Usual Adult Dose for Vaginal Candidiasis

150 mg orally as a single dose

Infectious Diseases Society of America (IDSA) Recommendations:
-Uncomplicated vaginitis: 150 mg orally as a single dose
-Management of recurrent vulvovaginal candidiasis (after 10 to 14 days induction therapy): 150 mg orally once a week for 6 months
-Complicated vulvovaginal candidiasis: 150 mg orally every 72 hours for 3 doses

US CDC Recommendations:
-Uncomplicated vulvovaginal candidiasis: 150 mg orally as a single dose
-Initial therapy for recurrent vulvovaginal candidiasis: 100 to 200 mg orally every 72 hours for 3 doses
-Maintenance therapy for recurrent vulvovaginal candidiasis: 100 to 200 mg orally once a week for 6 months
-Severe vulvovaginal candidiasis: 150 mg orally every 72 hours for 2 doses

US CDC, National Institutes of Health (NIH), and IDSA Recommendations for HIV-infected Patients:
-Uncomplicated vulvovaginal candidiasis: 150 mg orally as a single dose
-Severe or recurrent vulvovaginal candidiasis: 100 to 200 mg orally once a day for at least 7 days
-Suppressive therapy for vulvovaginal candidiasis: 150 mg orally once a week

Comments:
-Recommended as preferred therapy
-Unless frequent or severe recurrences, suppressive therapy generally not recommended

Usual Adult Dose for Oral Thrush

Oropharyngeal candidiasis: 200 mg IV or orally on the first day followed by 100 mg IV or orally once a day
Duration of therapy: At least 2 weeks, to reduce the risk of relapse

IDSA Recommendations:
-Moderate to severe oropharyngeal candidiasis: 100 to 200 mg IV or orally once a day for 7 to 14 days

Comments:
-Recommended as primary therapy

US CDC, NIH, and IDSA Recommendations for HIV-infected Patients:
-Initial episodes of oropharyngeal candidiasis: 100 mg orally once a day for 7 to 14 days
-Suppressive therapy for oropharyngeal candidiasis: 100 mg orally once a day or 3 times a week

Comments:
-Recommended as preferred oral therapy
-Unless frequent or severe recurrences, suppressive therapy generally not recommended

Usual Adult Dose for Candidemia

Doses up to 400 mg/day have been used.

Comments:
-Optimal therapeutic dose and therapy duration have not been established.

Use: For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia

IDSA Recommendations:
Candidemia in nonneutropenic or neutropenic patients: 800 mg IV or orally on the first day followed by 400 mg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: 14 days after first negative blood culture and candidemia signs/symptoms resolve
-Neutropenic patients: 2 weeks after Candida cleared from bloodstream (documented) and candidemia symptoms and neutropenia resolve

Chronic disseminated candidiasis in stable patients: 400 mg IV or orally once a day
Duration of therapy: Until lesions have resolved (usually months) and through periods of immunosuppression

Candida osteoarticular infection: 400 mg IV or orally once a day
Duration of therapy:
-Osteomyelitis: 6 to 12 months
-Septic arthritis: At least 6 weeks

CNS candidiasis (after initial regimen of IV amphotericin B): 400 to 800 mg IV or orally once a day
Duration of therapy: Until all signs/symptoms and CSF and radiologic abnormalities resolve

Candida cardiovascular system infection: 400 to 800 mg IV or orally once a day
Duration of therapy:
-Endocarditis: Lifelong suppressive therapy may be indicated.
-Pericarditis or myocarditis: Often several months
-Suppurative thrombophlebitis: At least 2 weeks after candidemia cleared
-Infected pacemaker, implantable cardioverter defibrillator (ICD), or ventricular assist device (VAD): 4 to 6 weeks after device removed; chronic suppressive therapy if VAD not removed

Comments:
-Candidemia in nonneutropenic patients: Recommended as primary therapy; an echinocandin is recommended for moderately severe to severe illness or recent azole exposure; switching to this drug after initial echinocandin is often appropriate.
-Candidemia in neutropenic patients: Recommended as alternative therapy; an echinocandin or IV amphotericin B preferred for most patients; this drug recommended for patients without recent azole exposure and who are not critically ill.
-Recommended as primary therapy for chronic disseminated candidiasis in stable patients, Candida osteoarticular infection, CNS candidiasis, pericarditis/myocarditis, and suppurative thrombophlebitis
-Recommended as alternative therapy for endocarditis and infected pacemaker, ICD, or VAD

Usual Adult Dose for Fungal Pneumonia

Doses up to 400 mg/day have been used.

Comments:
-Optimal therapeutic dose and therapy duration have not been established.

Use: For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia

IDSA Recommendations:
Candidemia in nonneutropenic or neutropenic patients: 800 mg IV or orally on the first day followed by 400 mg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: 14 days after first negative blood culture and candidemia signs/symptoms resolve
-Neutropenic patients: 2 weeks after Candida cleared from bloodstream (documented) and candidemia symptoms and neutropenia resolve

Chronic disseminated candidiasis in stable patients: 400 mg IV or orally once a day
Duration of therapy: Until lesions have resolved (usually months) and through periods of immunosuppression

Candida osteoarticular infection: 400 mg IV or orally once a day
Duration of therapy:
-Osteomyelitis: 6 to 12 months
-Septic arthritis: At least 6 weeks

CNS candidiasis (after initial regimen of IV amphotericin B): 400 to 800 mg IV or orally once a day
Duration of therapy: Until all signs/symptoms and CSF and radiologic abnormalities resolve

Candida cardiovascular system infection: 400 to 800 mg IV or orally once a day
Duration of therapy:
-Endocarditis: Lifelong suppressive therapy may be indicated.
-Pericarditis or myocarditis: Often several months
-Suppurative thrombophlebitis: At least 2 weeks after candidemia cleared
-Infected pacemaker, implantable cardioverter defibrillator (ICD), or ventricular assist device (VAD): 4 to 6 weeks after device removed; chronic suppressive therapy if VAD not removed

Comments:
-Candidemia in nonneutropenic patients: Recommended as primary therapy; an echinocandin is recommended for moderately severe to severe illness or recent azole exposure; switching to this drug after initial echinocandin is often appropriate.
-Candidemia in neutropenic patients: Recommended as alternative therapy; an echinocandin or IV amphotericin B preferred for most patients; this drug recommended for patients without recent azole exposure and who are not critically ill.
-Recommended as primary therapy for chronic disseminated candidiasis in stable patients, Candida osteoarticular infection, CNS candidiasis, pericarditis/myocarditis, and suppurative thrombophlebitis
-Recommended as alternative therapy for endocarditis and infected pacemaker, ICD, or VAD

Usual Adult Dose for Fungal Infection - Disseminated

Doses up to 400 mg/day have been used.

Comments:
-Optimal therapeutic dose and therapy duration have not been established.

Use: For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia

IDSA Recommendations:
Candidemia in nonneutropenic or neutropenic patients: 800 mg IV or orally on the first day followed by 400 mg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: 14 days after first negative blood culture and candidemia signs/symptoms resolve
-Neutropenic patients: 2 weeks after Candida cleared from bloodstream (documented) and candidemia symptoms and neutropenia resolve

Chronic disseminated candidiasis in stable patients: 400 mg IV or orally once a day
Duration of therapy: Until lesions have resolved (usually months) and through periods of immunosuppression

Candida osteoarticular infection: 400 mg IV or orally once a day
Duration of therapy:
-Osteomyelitis: 6 to 12 months
-Septic arthritis: At least 6 weeks

CNS candidiasis (after initial regimen of IV amphotericin B): 400 to 800 mg IV or orally once a day
Duration of therapy: Until all signs/symptoms and CSF and radiologic abnormalities resolve

Candida cardiovascular system infection: 400 to 800 mg IV or orally once a day
Duration of therapy:
-Endocarditis: Lifelong suppressive therapy may be indicated.
-Pericarditis or myocarditis: Often several months
-Suppurative thrombophlebitis: At least 2 weeks after candidemia cleared
-Infected pacemaker, implantable cardioverter defibrillator (ICD), or ventricular assist device (VAD): 4 to 6 weeks after device removed; chronic suppressive therapy if VAD not removed

Comments:
-Candidemia in nonneutropenic patients: Recommended as primary therapy; an echinocandin is recommended for moderately severe to severe illness or recent azole exposure; switching to this drug after initial echinocandin is often appropriate.
-Candidemia in neutropenic patients: Recommended as alternative therapy; an echinocandin or IV amphotericin B preferred for most patients; this drug recommended for patients without recent azole exposure and who are not critically ill.
-Recommended as primary therapy for chronic disseminated candidiasis in stable patients, Candida osteoarticular infection, CNS candidiasis, pericarditis/myocarditis, and suppurative thrombophlebitis
-Recommended as alternative therapy for endocarditis and infected pacemaker, ICD, or VAD

Usual Adult Dose for Systemic Candidiasis

Doses up to 400 mg/day have been used.

Comments:
-Optimal therapeutic dose and therapy duration have not been established.

Use: For systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia

IDSA Recommendations:
Candidemia in nonneutropenic or neutropenic patients: 800 mg IV or orally on the first day followed by 400 mg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: 14 days after first negative blood culture and candidemia signs/symptoms resolve
-Neutropenic patients: 2 weeks after Candida cleared from bloodstream (documented) and candidemia symptoms and neutropenia resolve

Chronic disseminated candidiasis in stable patients: 400 mg IV or orally once a day
Duration of therapy: Until lesions have resolved (usually months) and through periods of immunosuppression

Candida osteoarticular infection: 400 mg IV or orally once a day
Duration of therapy:
-Osteomyelitis: 6 to 12 months
-Septic arthritis: At least 6 weeks

CNS candidiasis (after initial regimen of IV amphotericin B): 400 to 800 mg IV or orally once a day
Duration of therapy: Until all signs/symptoms and CSF and radiologic abnormalities resolve

Candida cardiovascular system infection: 400 to 800 mg IV or orally once a day
Duration of therapy:
-Endocarditis: Lifelong suppressive therapy may be indicated.
-Pericarditis or myocarditis: Often several months
-Suppurative thrombophlebitis: At least 2 weeks after candidemia cleared
-Infected pacemaker, implantable cardioverter defibrillator (ICD), or ventricular assist device (VAD): 4 to 6 weeks after device removed; chronic suppressive therapy if VAD not removed

Comments:
-Candidemia in nonneutropenic patients: Recommended as primary therapy; an echinocandin is recommended for moderately severe to severe illness or recent azole exposure; switching to this drug after initial echinocandin is often appropriate.
-Candidemia in neutropenic patients: Recommended as alternative therapy; an echinocandin or IV amphotericin B preferred for most patients; this drug recommended for patients without recent azole exposure and who are not critically ill.
-Recommended as primary therapy for chronic disseminated candidiasis in stable patients, Candida osteoarticular infection, CNS candidiasis, pericarditis/myocarditis, and suppurative thrombophlebitis
-Recommended as alternative therapy for endocarditis and infected pacemaker, ICD, or VAD

Usual Adult Dose for Esophageal Candidiasis

200 mg IV or orally on the first day followed by 100 mg IV or orally once a day
Duration of therapy: At least 3 weeks and for at least 2 weeks after symptoms resolve

Comments:
-Doses up to 400 mg/day may be used based on clinical judgment of patient response.

IDSA Recommendations: 200 to 400 mg IV or orally once a day for 14 to 21 days

Comments:
-Recommended as primary therapy; oral fluconazole is preferred.

US CDC, NIH, and IDSA Recommendations for HIV-infected Patients: 100 to 400 mg IV or orally once a day for 14 to 21 days
-Suppressive therapy: 100 to 200 mg orally once a day

Comments:
-Recommended as preferred therapy
-Unless frequent or severe recurrences, suppressive therapy generally not recommended

Usual Adult Dose for Candida Urinary Tract Infection

50 to 200 mg IV or orally once a day

Use: For the treatment of Candida urinary tract infections and peritonitis

IDSA Recommendations:
-Asymptomatic cystitis in patients undergoing urologic procedures: 200 to 400 mg IV or orally once a day for several days before and after the procedure
-Symptomatic cystitis: 200 mg IV or orally once a day for 2 weeks
-Pyelonephritis: 200 to 400 mg IV or orally once a day for 2 weeks
-Urinary fungus balls: 200 to 400 mg IV or orally once a day until symptoms resolve and urine cultures clear of Candida

Comments:
-Recommended as primary therapy
-The suggested dose for candidemia is recommended for patients with pyelonephritis and suspected disseminated candidiasis.
-Surgical removal of urinary fungus balls strongly recommended.

Usual Adult Dose for Fungal Peritonitis

50 to 200 mg IV or orally once a day

Use: For the treatment of Candida urinary tract infections and peritonitis

IDSA Recommendations:
-Asymptomatic cystitis in patients undergoing urologic procedures: 200 to 400 mg IV or orally once a day for several days before and after the procedure
-Symptomatic cystitis: 200 mg IV or orally once a day for 2 weeks
-Pyelonephritis: 200 to 400 mg IV or orally once a day for 2 weeks
-Urinary fungus balls: 200 to 400 mg IV or orally once a day until symptoms resolve and urine cultures clear of Candida

Comments:
-Recommended as primary therapy
-The suggested dose for candidemia is recommended for patients with pyelonephritis and suspected disseminated candidiasis.
-Surgical removal of urinary fungus balls strongly recommended.

Usual Adult Dose for Cryptococcal Meningitis - Immunocompetent Host

Acute infection: 400 mg IV or orally on the first day followed by 200 mg IV or orally once a day
Duration of therapy: 10 to 12 weeks after CSF culture is negative

Comments:
-Dose of 400 mg IV or orally once a day may be used based on clinical judgment of patient response.

IDSA Recommendations:
-Consolidation therapy (after induction therapy): 400 to 800 mg orally once a day for 8 weeks
-Maintenance therapy: 200 mg orally once a day for 6 to 12 months

Comments:
-Preferred agent
-The higher dose (800 mg/day) is recommended for consolidation therapy if the 2-week induction regimen was used.
-Maintenance therapy is recommended to prevent relapse.

Cerebral cryptococcoma:
-Consolidation and maintenance therapy (after induction therapy): 400 to 800 mg orally once a day for 6 to 18 months

Usual Adult Dose for Cryptococcal Meningitis - Immunosuppressed Host

Acute infection: 400 mg IV or orally on the first day followed by 200 mg IV or orally once a day
Duration of therapy: 10 to 12 weeks after CSF culture is negative

Comments:
-Dose of 400 mg IV or orally once a day may be used based on clinical judgment of patient response.

Suppression of relapse in patients with AIDS: 200 mg IV or orally once a day

IDSA Recommendations:
HIV-infected patients:
-Induction therapy: 800 to 2000 mg orally once a day for 6 to 12 weeks, depending on regimen
-Consolidation therapy (after induction therapy): 400 mg orally once a day for at least 8 weeks
-Maintenance (suppressive) and prophylactic therapy: 200 mg orally once a day for at least 12 months

Comments:
-Recommended as an alternative for induction therapy; use is not encouraged.
-Preferred agent for consolidation therapy and maintenance and prophylactic therapy

Organ transplant recipients:
-Consolidation therapy (after induction therapy): 400 to 800 mg orally once a day for 8 weeks
-Maintenance therapy: 200 to 400 mg orally once a day for 6 to 12 months

Comments:
-Preferred agent

Cerebral cryptococcoma:
-Consolidation and maintenance therapy (after induction therapy): 400 to 800 mg orally once a day for 6 to 18 months

US CDC, NIH, and IDSA Recommendations for HIV-infected Patients:
-Induction therapy: 400 to 1200 mg IV or orally once a day for at least 2 weeks
-Consolidation therapy (after at least 2 weeks successful induction therapy): 400 mg IV or orally once a day for at least 8 weeks
-Maintenance therapy: 200 mg orally once a day for at least 1 year

Comments:
-Recommended for use in alternative regimens for induction therapy; dose depends on regimen (i.e., used with amphotericin B, flucytosine, or alone).
-Recommended as preferred regimen for consolidation therapy; should be followed by maintenance therapy
-Recommended as preferred regimen for maintenance therapy

Usual Adult Dose for Cryptococcosis

IDSA Recommendations:
Mild to moderate pulmonary infection and nonmeningeal, nonpulmonary infection if CNS disease ruled out, no fungemia, single site of infection, no immunosuppressive risk factors: 400 mg orally once a day for 6 to 12 months

Severe pulmonary infection and nonmeningeal, nonpulmonary infection with cryptococcemia:
-Consolidation therapy (after induction therapy): 400 to 800 mg orally once a day for at least 8 weeks
-Maintenance therapy: 200 to 400 mg orally once a day for 12 months

Comments:
-Preferred agent
-Maintenance therapy is recommended to prevent relapse.
-Primary prophylaxis not routinely recommended.

US CDC, NIH, and IDSA Recommendations for HIV-infected Patients:
Non-CNS cryptococcosis with mild to moderate symptoms and focal pulmonary infiltrates: 400 mg orally once a day for 12 months

Non-CNS, extrapulmonary cryptococcosis and diffuse pulmonary disease:
-Induction therapy: 400 to 1200 mg IV or orally once a day for at least 2 weeks
-Consolidation therapy (after at least 2 weeks successful induction therapy): 400 mg IV or orally once a day for at least 8 weeks
-Maintenance therapy: 200 mg orally once a day for at least 1 year

Comments:
-Recommended for use in alternative regimens for induction therapy; dose depends on regimen (i.e., used with amphotericin B, flucytosine, or alone).
-Recommended as preferred regimen for consolidation therapy; should be followed by maintenance therapy
-Recommended as preferred regimen for maintenance therapy

Usual Adult Dose for Fungal Infection Prophylaxis

400 mg IV or orally once a day
Duration of therapy: 7 days after neutrophil count rises above 1000 cells/mm3

Comments:
-If severe granulocytopenia (less than 500 neutrophils/mm3) is expected, prophylaxis should start several days before the likely onset of neutropenia.

Use: For prophylaxis to reduce the incidence of candidiasis in bone marrow transplantation recipients who receive cytotoxic chemotherapy and/or radiation therapy

IDSA Recommendations:
Empiric therapy for suspected candidiasis in nonneutropenic or neutropenic patients: 800 mg IV or orally on the first day followed by 400 mg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: Uncertain; should discontinue if cultures and/or serodiagnostic test results negative

Comments:
-Suspected candidiasis in nonneutropenic patients: Recommended as primary therapy; an echinocandin is preferred for moderately severe to severe illness or recent azole exposure; patient selection should be based on clinical risk factors, serologic tests, and culture data.
-Suspected candidiasis in neutropenic patients: Recommended as alternative therapy; should start empiric therapy after 4 days persistent fever despite antibiotics; serodiagnostic and computed tomography (CT) imaging may help; should not use in patients with prior azole prophylaxis.

Usual Adult Dose for Coccidioidomycosis - Meningitis

IDSA Recommendations: 400 mg orally once a day

Comments:
-Some experts start therapy with 800 to 1000 mg/day.
-Patients who respond to therapy should continue this treatment indefinitely.

US CDC, NIH, and IDSA Recommendations for HIV-infected Patients:
-Meningeal infection: 400 to 800 mg IV or orally once a day
-Chronic suppressive therapy: 400 mg orally once a day

Comments:
-Recommended as preferred therapy for meningeal infection and chronic suppressive therapy
-A specialist should be consulted for meningeal infections.
-Since relapse is common (80%), suppressive therapy should be lifelong.

Usual Adult Dose for Coccidioidomycosis

IDSA Recommendations: 400 to 800 mg IV or orally once a day
Duration of therapy:
-Uncomplicated coccidioidal pneumonia: 3 to 6 months
-Diffuse pneumonia and chronic progressive fibrocavitary pneumonia: At least 1 year

Comments:
-Therapy for diffuse pneumonia is usually started with high-dose fluconazole; if therapy started with IV amphotericin B (e.g., if significant hypoxia or rapid deterioration), may switch to oral azole antifungal therapy after evident improvement; total duration of therapy should be at least 1 year; oral azole therapy should continue as secondary prophylaxis in severely immunodeficient patients.
-Initial therapy with oral azole antifungals is recommended for chronic progressive fibrocavitary pneumonia.
-Initial therapy for nonmeningeal disseminated infection (extrapulmonary) is generally started with oral azole antifungals, most often fluconazole or itraconazole; clinical trials used 400 mg/day; some experts recommend up to 2 g/day of fluconazole.

US CDC, NIH, and IDSA Recommendations for HIV-infected Patients:
-Primary prophylaxis: 400 mg orally once a day
-Mild infections (e.g., focal pneumonia): 400 mg orally once a day
-Severe nonmeningeal infection (diffuse pulmonary or severely ill patients with extrathoracic disseminated disease) - acute phase: 400 mg IV or orally once a day
-Chronic suppressive therapy (secondary prophylaxis): 400 mg orally once a day

Comments:
-Recommended as preferred therapy for mild infection and chronic suppressive therapy
-Recommended as alternative therapy for severe nonmeningeal infection; some experts add a triazole to amphotericin B (preferred therapy) and continue the triazole after amphotericin B is stopped.

Usual Adult Dose for Histoplasmosis

IDSA Recommendations:
-Disseminated infections in patients without AIDS: 200 to 800 mg IV or orally once a day for at least 12 months
-CNS infection (after initial regimen of IV amphotericin B): 200 to 400 mg IV or orally once a day for 12 months

Comments:
-Recommended as alternative therapy in patients unable to use itraconazole

US CDC, NIH, and IDSA Recommendations for HIV-infected Patients:
-Less severe disseminated infection: 800 mg orally once a day for at least 12 months
-Long-term suppressive therapy (secondary prophylaxis): 400 mg orally once a day for more than 1 year

Comments:
-Recommended as alternative therapy
-This drug should only be used for treatment of less severe disseminated infection in moderately ill patients intolerant of itraconazole.

Usual Adult Dose for Blastomycosis

IDSA Recommendations:
-Mild to moderate pulmonary infection or mild to moderate disseminated infection without CNS involvement: 400 to 800 mg orally once a day for at least 6 to 12 months
-CNS infection (after initial regimen of IV amphotericin B): 800 mg orally once a day for at least 12 months and until CSF abnormalities resolve

Comments:
-Recommended as alternative therapy for mild to moderate pulmonary infection or mild to moderate disseminated infection without CNS involvement
-Recommended as follow-up therapy for CNS infection

Usual Adult Dose for Onychomycosis - Fingernail

Some experts recommend: 150 to 300 mg orally once a week
Duration of therapy:
-Fingernail infections: 3 to 6 months
-Toenail infections: 6 to 12 months

Usual Adult Dose for Onychomycosis - Toenail

Some experts recommend: 150 to 300 mg orally once a week
Duration of therapy:
-Fingernail infections: 3 to 6 months
-Toenail infections: 6 to 12 months

Usual Adult Dose for Sporotrichosis

IDSA Recommendations:
Cutaneous or lymphocutaneous infection: 400 to 800 mg IV or orally once a day
Duration of therapy: 2 to 4 weeks after all lesions resolve (usually 3 to 6 months total)

Comments:
-Recommended as alternative therapy; should only be used if other agents are not tolerated

Usual Pediatric Dose for Esophageal Candidiasis

2 weeks or younger (gestational age 26 to 29 weeks): 3 mg/kg IV or orally every 72 hours
Older than 2 weeks: 6 mg/kg IV or orally on the first day followed by 3 mg/kg IV or orally once a day
Duration of therapy: At least 3 weeks and for at least 2 weeks after symptoms resolve

Comments:
-Doses up to 12 mg/kg/day may be used in patients older than 2 weeks based on clinical judgment of patient response; this correlates to 12 mg/kg/72 hours in premature newborns during their first 2 weeks of life.

IDSA Recommendations: 3 to 6 mg/kg IV or orally once a day for 14 to 21 days

Comments:
-Recommended as primary therapy; oral fluconazole is preferred.

US CDC, NIH, IDSA, Pediatric Infectious Diseases Society (PIDS), and American Academy of Pediatrics (AAP) Recommendations for HIV-exposed and HIV-infected Children: 6 to 12 mg/kg IV or orally once a day
Maximum dose: 600 mg/dose
Duration of therapy: At least 3 weeks and for at least 2 weeks after symptoms resolve

Comments:
-Oral fluconazole recommended as preferred therapy; IV dosing recommended as alternative therapy for infants and children of all ages.
-If neonate creatinine level is greater than 1.2 mg/dL for 3 consecutive doses, the dosing interval for the higher dose may be extended to 12 mg/kg every 48 hours until serum creatinine level is less than 1.2 mg/dL.

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents: 100 to 400 mg IV or orally once a day for 14 to 21 days
-Suppressive therapy: 100 to 200 mg orally once a day

Comments:
-Recommended as preferred therapy
-Unless frequent or severe recurrences, suppressive therapy generally not recommended

Usual Pediatric Dose for Oral Thrush

Oropharyngeal candidiasis:
2 weeks or younger (gestational age 26 to 29 weeks): 3 mg/kg IV or orally every 72 hours
Older than 2 weeks: 6 mg/kg IV or orally on the first day followed by 3 mg/kg IV or orally once a day
Duration of therapy: At least 2 weeks, to reduce the risk of relapse

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children: 6 to 12 mg/kg orally once a day
Maximum dose: 400 mg/dose
Duration of therapy: 7 to 14 days

Comments:
-Recommended as preferred therapy; oral fluconazole recommended for moderate or severe oropharyngeal candidiasis.

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents:
-Initial episodes: 100 mg orally once a day for 7 to 14 days
-Suppressive therapy: 100 mg orally once a day or 3 times a week

Comments:
-Recommended as preferred oral therapy
-Unless frequent or severe recurrences, suppressive therapy generally not recommended

Usual Pediatric Dose for Candidemia

2 weeks or younger (gestational age 26 to 29 weeks): 6 to 12 mg/kg IV or orally every 72 hours
Older than 2 weeks: 6 to 12 mg/kg/day IV or orally

Use: For the treatment of candidemia and disseminated Candida infections

IDSA Recommendations:
Neonatal candidiasis: 12 mg/kg IV or orally once a day for at least 3 weeks

Candidemia in nonneutropenic or neutropenic patients: 12 mg/kg IV or orally on the first day followed by 6 mg/kg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: 14 days after first negative blood culture and candidemia signs/symptoms resolve
-Neutropenic patients: 2 weeks after Candida cleared from bloodstream (documented) and candidemia symptoms and neutropenia resolve

Chronic disseminated candidiasis in stable patients: 6 mg/kg IV or orally once a day
Duration of therapy: Until lesions have resolved (usually months) and through periods of immunosuppression

Candida osteoarticular infection: 6 mg/kg IV or orally once a day
Duration of therapy:
-Osteomyelitis: 6 to 12 months
-Septic arthritis: At least 6 weeks

CNS candidiasis (after initial regimen of IV amphotericin B): 6 to 12 mg/kg IV or orally once a day
Duration of therapy: Until all signs/symptoms and CSF and radiologic abnormalities resolve

Candida cardiovascular system infection: 6 to 12 mg/kg IV or orally once a day
Duration of therapy:
-Endocarditis: Lifelong suppressive therapy may be indicated.
-Pericarditis or myocarditis: Often several months
-Suppurative thrombophlebitis: At least 2 weeks after candidemia cleared
-Infected pacemaker, ICD, or VAD: 4 to 6 weeks after device removed; chronic suppressive therapy if VAD not removed

Comments:
-Recommended as primary therapy for neonatal candidiasis
-Candidemia in nonneutropenic patients: Recommended as primary therapy; an echinocandin is recommended for moderately severe to severe illness or recent azole exposure; switching to this drug after initial echinocandin is appropriate in many cases.
-Candidemia in neutropenic patients: Recommended as alternative therapy; an echinocandin or IV amphotericin B preferred for most patients; this drug recommended for patients without recent azole exposure and who are not critically ill.
-Recommended as primary therapy for chronic disseminated candidiasis in stable patients, Candida osteoarticular infection, CNS candidiasis, pericarditis/myocarditis, and suppurative thrombophlebitis
-Recommended as alternative therapy for endocarditis and infected pacemaker, ICD, or VAD

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Invasive disease in infants and children (all ages): 12 mg/kg IV once a day
Maximum dose: 600 mg/dose
Duration of therapy: Based on presence of deep-tissue foci and clinical response
-Uncomplicated candidemia: At least 2 weeks after last positive blood culture

Secondary prophylaxis: 3 to 6 mg/kg IV or orally once a day
Maximum dose: 200 mg/dose

Comments:
-Recommended as alternative therapy in critically ill patients with invasive disease
-Recommended as preferred therapy in patients with invasive disease who are not critically ill; this drug should be avoided for Candida krusei and C glabrata.
-Secondary prophylaxis may be considered for frequent or severe recurrences of candidiasis; not routinely recommended.

Usual Pediatric Dose for Fungal Infection - Disseminated

2 weeks or younger (gestational age 26 to 29 weeks): 6 to 12 mg/kg IV or orally every 72 hours
Older than 2 weeks: 6 to 12 mg/kg/day IV or orally

Use: For the treatment of candidemia and disseminated Candida infections

IDSA Recommendations:
Neonatal candidiasis: 12 mg/kg IV or orally once a day for at least 3 weeks

Candidemia in nonneutropenic or neutropenic patients: 12 mg/kg IV or orally on the first day followed by 6 mg/kg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: 14 days after first negative blood culture and candidemia signs/symptoms resolve
-Neutropenic patients: 2 weeks after Candida cleared from bloodstream (documented) and candidemia symptoms and neutropenia resolve

Chronic disseminated candidiasis in stable patients: 6 mg/kg IV or orally once a day
Duration of therapy: Until lesions have resolved (usually months) and through periods of immunosuppression

Candida osteoarticular infection: 6 mg/kg IV or orally once a day
Duration of therapy:
-Osteomyelitis: 6 to 12 months
-Septic arthritis: At least 6 weeks

CNS candidiasis (after initial regimen of IV amphotericin B): 6 to 12 mg/kg IV or orally once a day
Duration of therapy: Until all signs/symptoms and CSF and radiologic abnormalities resolve

Candida cardiovascular system infection: 6 to 12 mg/kg IV or orally once a day
Duration of therapy:
-Endocarditis: Lifelong suppressive therapy may be indicated.
-Pericarditis or myocarditis: Often several months
-Suppurative thrombophlebitis: At least 2 weeks after candidemia cleared
-Infected pacemaker, ICD, or VAD: 4 to 6 weeks after device removed; chronic suppressive therapy if VAD not removed

Comments:
-Recommended as primary therapy for neonatal candidiasis
-Candidemia in nonneutropenic patients: Recommended as primary therapy; an echinocandin is recommended for moderately severe to severe illness or recent azole exposure; switching to this drug after initial echinocandin is appropriate in many cases.
-Candidemia in neutropenic patients: Recommended as alternative therapy; an echinocandin or IV amphotericin B preferred for most patients; this drug recommended for patients without recent azole exposure and who are not critically ill.
-Recommended as primary therapy for chronic disseminated candidiasis in stable patients, Candida osteoarticular infection, CNS candidiasis, pericarditis/myocarditis, and suppurative thrombophlebitis
-Recommended as alternative therapy for endocarditis and infected pacemaker, ICD, or VAD

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Invasive disease in infants and children (all ages): 12 mg/kg IV once a day
Maximum dose: 600 mg/dose
Duration of therapy: Based on presence of deep-tissue foci and clinical response
-Uncomplicated candidemia: At least 2 weeks after last positive blood culture

Secondary prophylaxis: 3 to 6 mg/kg IV or orally once a day
Maximum dose: 200 mg/dose

Comments:
-Recommended as alternative therapy in critically ill patients with invasive disease
-Recommended as preferred therapy in patients with invasive disease who are not critically ill; this drug should be avoided for Candida krusei and C glabrata.
-Secondary prophylaxis may be considered for frequent or severe recurrences of candidiasis; not routinely recommended.

Usual Pediatric Dose for Systemic Candidiasis

2 weeks or younger (gestational age 26 to 29 weeks): 6 to 12 mg/kg IV or orally every 72 hours
Older than 2 weeks: 6 to 12 mg/kg/day IV or orally

Use: For the treatment of candidemia and disseminated Candida infections

IDSA Recommendations:
Neonatal candidiasis: 12 mg/kg IV or orally once a day for at least 3 weeks

Candidemia in nonneutropenic or neutropenic patients: 12 mg/kg IV or orally on the first day followed by 6 mg/kg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: 14 days after first negative blood culture and candidemia signs/symptoms resolve
-Neutropenic patients: 2 weeks after Candida cleared from bloodstream (documented) and candidemia symptoms and neutropenia resolve

Chronic disseminated candidiasis in stable patients: 6 mg/kg IV or orally once a day
Duration of therapy: Until lesions have resolved (usually months) and through periods of immunosuppression

Candida osteoarticular infection: 6 mg/kg IV or orally once a day
Duration of therapy:
-Osteomyelitis: 6 to 12 months
-Septic arthritis: At least 6 weeks

CNS candidiasis (after initial regimen of IV amphotericin B): 6 to 12 mg/kg IV or orally once a day
Duration of therapy: Until all signs/symptoms and CSF and radiologic abnormalities resolve

Candida cardiovascular system infection: 6 to 12 mg/kg IV or orally once a day
Duration of therapy:
-Endocarditis: Lifelong suppressive therapy may be indicated.
-Pericarditis or myocarditis: Often several months
-Suppurative thrombophlebitis: At least 2 weeks after candidemia cleared
-Infected pacemaker, ICD, or VAD: 4 to 6 weeks after device removed; chronic suppressive therapy if VAD not removed

Comments:
-Recommended as primary therapy for neonatal candidiasis
-Candidemia in nonneutropenic patients: Recommended as primary therapy; an echinocandin is recommended for moderately severe to severe illness or recent azole exposure; switching to this drug after initial echinocandin is appropriate in many cases.
-Candidemia in neutropenic patients: Recommended as alternative therapy; an echinocandin or IV amphotericin B preferred for most patients; this drug recommended for patients without recent azole exposure and who are not critically ill.
-Recommended as primary therapy for chronic disseminated candidiasis in stable patients, Candida osteoarticular infection, CNS candidiasis, pericarditis/myocarditis, and suppurative thrombophlebitis
-Recommended as alternative therapy for endocarditis and infected pacemaker, ICD, or VAD

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Invasive disease in infants and children (all ages): 12 mg/kg IV once a day
Maximum dose: 600 mg/dose
Duration of therapy: Based on presence of deep-tissue foci and clinical response
-Uncomplicated candidemia: At least 2 weeks after last positive blood culture

Secondary prophylaxis: 3 to 6 mg/kg IV or orally once a day
Maximum dose: 200 mg/dose

Comments:
-Recommended as alternative therapy in critically ill patients with invasive disease
-Recommended as preferred therapy in patients with invasive disease who are not critically ill; this drug should be avoided for Candida krusei and C glabrata.
-Secondary prophylaxis may be considered for frequent or severe recurrences of candidiasis; not routinely recommended.

Usual Pediatric Dose for Cryptococcal Meningitis - Immunocompetent Host

Acute infection:
2 weeks or younger (gestational age 26 to 29 weeks): 6 mg/kg IV or orally every 72 hours
Older than 2 weeks: 12 mg/kg IV or orally on the first day followed by 6 mg/kg IV or orally once a day
Duration of therapy: 10 to 12 weeks after CSF culture is negative

Comments:
-Dose of 12 mg/kg IV or orally once a day may be used in patients older than 2 weeks based on clinical judgment of patient response; this correlates to 12 mg/kg IV or orally every 72 hours in premature newborns during their first 2 weeks of life.

IDSA Recommendations:
CNS infection in children:
-Consolidation therapy (after induction therapy): 10 to 12 mg/kg orally once a day for 8 weeks
-Maintenance therapy: 6 mg/kg orally once a day

Comments:
-Preferred agent
-Maintenance therapy is recommended to prevent relapse.

Usual Pediatric Dose for Cryptococcal Meningitis - Immunosuppressed Host

Acute infection:
2 weeks or younger (gestational age 26 to 29 weeks): 6 mg/kg IV or orally every 72 hours
Older than 2 weeks: 12 mg/kg IV or orally on the first day followed by 6 mg/kg IV or orally once a day
Duration of therapy: 10 to 12 weeks after CSF culture is negative

Comments:
-Dose of 12 mg/kg IV or orally once a day may be used in patients older than 2 weeks based on clinical judgment of patient response; this correlates to 12 mg/kg IV or orally every 72 hours in premature newborns during their first 2 weeks of life.

Suppression of relapse in children with AIDS: 6 mg/kg IV or orally once a day

IDSA Recommendations for children:
CNS disease:
-Consolidation therapy (after induction therapy): 10 to 12 mg/kg/day orally in 2 divided doses for 8 weeks
-Maintenance therapy in HIV-infected patients: 6 mg/kg orally once a day

Comments:
-Preferred agent
-Maintenance therapy is recommended to prevent relapse.

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Acute therapy (induction): 12 mg/kg IV or orally on the first day followed by 10 to 12 mg/kg IV or orally once a day
Maximum dose: 800 mg/dose
Duration of therapy: At least 2 weeks

Consolidation therapy: 12 mg/kg IV or orally on the first day followed by 10 to 12 mg/kg IV or orally once a day
Maximum dose: 800 mg/dose
Duration of therapy: At least 8 weeks

Secondary prophylaxis: 6 mg/kg orally once a day
Maximum dose: 200 mg/dose
Duration of therapy: At least 1 year

Comments:
-Recommended in alternative regimens for acute therapy if flucytosine not tolerated or unavailable or amphotericin B-based therapy not tolerated
-Recommended as preferred agent for consolidation therapy; should be followed by secondary prophylaxis
-Recommended as preferred therapy for secondary prophylaxis

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents:
-Induction therapy: 400 to 1200 mg IV or orally once a day for at least 2 weeks
-Consolidation therapy (after at least 2 weeks successful induction therapy): 400 mg IV or orally once a day for at least 8 weeks
-Maintenance therapy: 200 mg orally once a day for at least 1 year

Comments:
-Recommended for use in alternative regimens for induction therapy; dose depends on regimen (i.e., used with amphotericin B, flucytosine, or alone).
-Recommended as preferred regimen for consolidation therapy; should be followed by maintenance therapy
-Recommended as preferred regimen for maintenance therapy

Usual Pediatric Dose for Cryptococcosis

IDSA Recommendations for children:
Disseminated disease:
-Consolidation therapy (after induction therapy): 10 to 12 mg/kg/day orally in 2 divided doses for 8 weeks
-Maintenance therapy in HIV-infected patients: 6 mg/kg orally once a day

Cryptococcal pneumonia: 6 to 12 mg/kg orally once a day for 6 to 12 months

Comments:
-Preferred agent
-Maintenance therapy is recommended to prevent relapse.

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Localized disease (including isolated pulmonary disease [non-CNS]), disseminated disease (non-CNS), or severe pulmonary disease: 12 mg/kg IV or orally on the first day followed by 6 to 12 mg/kg IV or orally once a day
Maximum dose: 600 mg/dose
Duration of therapy: Based on site and severity of infection and clinical response

Secondary prophylaxis: 6 mg/kg orally once a day
Maximum dose: 200 mg/dose
Duration of therapy: At least 1 year

Comments:
-Recommended as preferred therapy for localized disease and secondary prophylaxis
-Recommended as alternative therapy for disseminated disease and severe pulmonary disease

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents:
Non-CNS cryptococcosis with mild to moderate symptoms and focal pulmonary infiltrates: 400 mg orally once a day for 12 months

Non-CNS, extrapulmonary cryptococcosis and diffuse pulmonary disease:
-Induction therapy: 400 to 1200 mg IV or orally once a day for at least 2 weeks
-Consolidation therapy (after at least 2 weeks successful induction therapy): 400 mg IV or orally once a day for at least 8 weeks
-Maintenance therapy: 200 mg orally once a day for at least 1 year

Comments:
-Recommended for use in alternative regimens for induction therapy; dose depends on regimen (i.e., used with amphotericin B, flucytosine, or alone).
-Recommended as preferred regimen for consolidation therapy; should be followed by maintenance therapy
-Recommended as preferred regimen for maintenance therapy

Usual Pediatric Dose for Fungal Infection Prophylaxis

IDSA Recommendations:
Empiric therapy for suspected candidiasis in nonneutropenic or neutropenic patients: 12 mg/kg IV or orally on the first day followed by 6 mg/kg IV or orally once a day
Duration of therapy:
-Nonneutropenic patients: Uncertain; should discontinue if cultures and/or serodiagnostic test results negative

Comments:
-Suspected candidiasis in nonneutropenic patients: Recommended as primary therapy; an echinocandin is preferred for moderately severe to severe illness or recent azole exposure; patient selection should be based on clinical risk factors, serologic tests, and culture data.
-Suspected candidiasis in neutropenic patients: Recommended as alternative therapy; should start empiric therapy after 4 days persistent fever despite antibiotics; serodiagnostic and CT imaging may help; should not use in patients with prior azole prophylaxis.

Usual Pediatric Dose for Candida Urinary Tract Infection

IDSA Recommendations:
-Asymptomatic cystitis in patients undergoing urologic procedures: 3 to 6 mg/kg IV or orally once a day for several days before and after the procedure
-Symptomatic cystitis: 3 mg/kg IV or orally once a day for 2 weeks
-Pyelonephritis: 3 to 6 mg/kg IV or orally once a day for 2 weeks
-Urinary fungus balls: 3 to 6 mg/kg IV or orally once a day until symptoms resolve and urine cultures clear of Candida

Comments:
-Recommended as primary therapy
-The suggested dose for candidemia is recommended for patients with pyelonephritis and suspected disseminated candidiasis.
-Surgical removal of urinary fungus balls strongly recommended in non-neonates.

Usual Pediatric Dose for Coccidioidomycosis - Meningitis

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Meningeal infection: 12 mg/kg IV or orally once a day
Maximum dose: 800 mg/dose

Secondary prophylaxis: 6 mg/kg orally once a day
Maximum dose: 400 mg/dose
Duration of therapy: Lifelong

Comments:
-Recommended as preferred therapy
-Secondary prophylaxis should follow treatment of meningeal infection.

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents:
-Meningeal infection: 400 to 800 mg IV or orally once a day
-Chronic suppressive therapy: 400 mg orally once a day

Comments:
-Recommended as preferred therapy for meningeal infection and chronic suppressive therapy
-A specialist should be consulted for meningeal infections.
-Since relapse is common (80%), suppressive therapy should be lifelong.

Usual Pediatric Dose for Coccidioidomycosis

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Severe illness with respiratory compromise due to diffuse pulmonary or disseminated nonmeningeal infection: 12 mg/kg IV or orally once a day
Maximum dose: 800 mg/dose
Duration of therapy: 1 year total

Mild to moderate nonmeningeal infection (e.g., focal pneumonia): 6 to 12 mg/kg IV or orally once a day
Maximum dose: 400 mg/dose

Secondary prophylaxis: 6 mg/kg orally once a day
Maximum dose: 400 mg/dose
Duration of therapy: Lifelong in patients with disseminated disease

Comments:
-Recommended as alternative therapy for severe illness with respiratory compromise due to diffuse pulmonary or disseminated nonmeningeal infection; should be followed by secondary prophylaxis
-After patient with severe illness with respiratory compromise due to diffuse pulmonary or disseminated nonmeningeal infection is stabilized using the preferred regimen, may switch to fluconazole to complete therapy (total duration: 1 year)
-Recommended as preferred therapy for secondary prophylaxis; usually recommended after initial induction therapy for disseminated disease; may also be used after milder disease

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents:
-Primary prophylaxis: 400 mg orally once a day
-Mild infections (e.g., focal pneumonia): 400 mg orally once a day
-Severe nonmeningeal infection (diffuse pulmonary or severely ill patients with extrathoracic disseminated disease) - acute phase: 400 mg IV or orally once a day
-Chronic suppressive therapy (secondary prophylaxis): 400 mg orally once a day

Comments:
-Recommended as preferred therapy for mild infection and chronic suppressive therapy
-Recommended as alternative therapy for severe nonmeningeal infection; some experts add a triazole to amphotericin B (preferred therapy) and continue the triazole after amphotericin B is stopped.

Usual Pediatric Dose for Vaginal Candidiasis

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents:
-Uncomplicated vulvovaginal candidiasis: 150 mg orally as a single dose
-Severe or recurrent vulvovaginal candidiasis: 100 to 200 mg orally once a day for at least 7 days
-Suppressive therapy for vulvovaginal candidiasis: 150 mg orally once a week

Comments:
-Recommended as preferred therapy
-Unless frequent or severe recurrences, suppressive therapy generally not recommended

Usual Pediatric Dose for Histoplasmosis

US CDC, NIH, IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
Acute primary pulmonary infection: 3 to 6 mg/kg orally once a day
Maximum dose: 200 mg/dose

Mild disseminated disease: 5 to 6 mg/kg IV or orally twice a day
Maximum dose: 300 mg/dose
Duration of therapy: 12 months

Secondary prophylaxis: 3 to 6 mg/kg orally once a day
Maximum dose: 200 mg/dose

Comments:
-Recommended as alternative therapy

US CDC, NIH, and IDSA Recommendations for HIV-infected Adolescents:
-Less severe disseminated infection: 800 mg orally once a day for at least 12 months
-Long-term suppressive therapy (secondary prophylaxis): 400 mg orally once a day for more than 1 year

Comments:
-Recommended as alternative therapy
-This drug should only be used for treatment of less severe disseminated infection in moderately ill patients intolerant of itraconazole.

Renal Dose Adjustments

Adults:
Single-dose therapy: No adjustment recommended.

Multiple-dose therapy:
CrCl 50 mL/min or less (no dialysis): 50 to 400 mg IV or orally as a loading dose followed by 50% of the usual daily dose (according to indication)

Children: Dose reduction should parallel that recommended for adults.

Comments:
-Caution is recommended.
-Further adjustment may be needed depending on clinical condition.

Liver Dose Adjustments

Caution is recommended.

Precautions

Efficacy has not been established in patients younger than 6 months.

Consult WARNINGS section for additional precautions.

Dialysis

Adults:
Single-dose therapy: No adjustment recommended.

Multiple-dose therapy:
Regular dialysis: 50 to 400 mg IV or orally as a loading dose followed by 100% of the usual daily dose (according to indication) after each dialysis session

Children: Dose reduction should parallel that recommended for adults.

Comments: Further adjustment may be needed depending on clinical condition.

Other Comments

Administration advice:
-In general, use a loading dose of twice the daily dose on the first day of therapy to reach plasma levels close to steady-state by the second day of therapy.
-May administer orally or by IV infusion; can take without regard to food
-Do not use absolute doses exceeding 600 mg/day in children; pediatric doses of 3, 6, and 12 mg/kg are generally equivalent to adult doses of 100, 200, and 400 mg, respectively.
-Administer the IV infusion at a maximum rate of about 200 mg/hour as a continuous infusion.
-Shake the oral suspension well before using; discard unused portion after 2 weeks.
-Determine the daily dose based on the infecting organism and patient response to therapy.
-Continue therapy until clinical parameters or laboratory tests indicate active fungal infection has subsided; an inadequate duration of therapy may lead to recurrence of active infection.

Storage requirements:
-Dry powder (oral suspension), tablets: Store below 30C (86F).
-Reconstituted oral suspension, IV injections in glass bottles: Store at 5C to 30C (41F to 86F); protect from freezing.
-IV injections in Viaflex(R) Plus plastic containers: Store at 5C to 25C (41F to 77F); brief exposure up to 40C (104F) does not harm product; protect from freezing.

Reconstitution/preparation techniques:
-The manufacturer product information should be consulted.

IV compatibility:
-Supplementary medication should not be added.

General:
-Current guidelines should be consulted for additional information.
-This drug is not approved by US FDA for treatment of infections other than vaginal candidiasis, oropharyngeal candidiasis, esophageal candidiasis, systemic Candida infections (candidemia, disseminated candidiasis, pneumonia), Candida urinary tract infections and peritonitis, and cryptococcal meningitis, or for prophylaxis other than to prevent candidiasis in bone marrow transplantation recipients and suppress relapse of cryptococcal meningitis in AIDS patients.
-Specimens for fungal culture and other relevant laboratory studies (histopathology, serology) should be obtained before therapy to isolate and identify causative organisms; therapy may be started before results are known, but once available, antifungal therapy should be adjusted accordingly.
-Since oral absorption is rapid and almost complete, the daily dose is the same for oral (tablets and suspension) and IV administration.
-The IV product has been used safely for up to 14 days.
-Maintenance therapy usually required for patients with AIDS and cryptococcal meningitis or recurrent oropharyngeal candidiasis to prevent relapse.

Monitoring:
-Dermatologic: For progression of lesions in patients with invasive/systemic fungal infections who develop rash
-Hepatic: For more severe hepatic injury in patients with abnormal liver function tests; signs/symptoms of liver disease due to this drug
-Renal: Renal function in elderly patients

Patient advice:
-On occasion, dizziness or seizures may occur; consider this when driving or operating machinery.

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