- Treatment of invasive candidal infections, esophageal candidiasis, UTI and pneumonia
- Treatment of thrush
- Prophylaxis for the prevention of invasive candidiasis
- IV intermittent infusion: over 1 - 2 hours (for doses > 6 mg/kg, administer IV over 2 hours)
- PO
Treatment - invasive candidiasis
GA 26-29 weeks:
- PNA 0-7 days: 12 mg/kg IV on day 1, followed by 12 mg/kg IV Q48h starting on day 2
- PNA >7 days: 12 mg/kg IV on day 1, followed by 12 mg/kg IV q24h starting on day 2
GA 30-40 weeks: 12 mg/kg IV q24h
AAP guidelines recommend a loading dose of 25mg/kg initially. This could be used in selected circumstances such as patients with severe illness, suspected CNS infections or patients on ECMO (considering hepatic and renal status as well as other potential medication interactions).
Treatment - oropharyngeal* candidiasis (thrush)
- 6mg/kg PO/IV q 24 hours
*maintenance doses up to 12 mg/kg may be required for treating esophageal candidiasis
Prophylaxis for the prevention of invasive candidiasis
Based upon the current available literature, our approach is not to start antifungal prophylaxis for all premature infants because of the concern of promoting resistant Candida species within the NICU.
Prophylactic fluconazole may be considered in infants with a high risk of invasive fungal infections such as extremely low birth weight infants (birth weight below 1000 g) with additional risk factors such as prolonged treatment with systemic broad-spectrum antibiotics.
Dosage adjustment required in renal impairment. Contact pharmacy for advice.
| Postnatal Age (PNA) | Gestatiional Age (GA) | Dose (PO/IV) | |
| 0 to < 42 days |
< 30 weeks | 3 to 6 mg/kg/dose* Q 72 hours | |
| > 30 weeks | 6 mg/kg/dose Q 48 hours | ||
| > 42 days | 6 mg/kg/dose Q 48 hours | ||
*3 mg/kg/dose is likely to be effective when local Candida isolate MICs are ≤2 mg/L; 6 mg/kg/dose is necessary when MICs are >2 mg/L or are unknown
- CVS: QT interval prolongation reported
- GI: nausea, vomiting, diarrhea, abdominal pain
- Hematologic: eosinophilia, leukopenia, thrombocytopenia (rare)
- Hepatic: elevated AST, ALT, or ALP; hepatitis; cholestasis
- Periodic liver function test
- Renal function
- Fluconazole 2 mg/mL:
- Available as Fluconazole 2 mg/mL solution: No reconstitution necessary
- Final concentration: 2 mg/mL
- Solutions Compatible: D5W or 0.9 % NaCl
- Y-site Compatible: acyclovir, dopamine, dobutamine, fentanyl, gentamicin, heparin, midazolam, morphine, tobramycin, TPN (amino acids- dextrose), vancomycin
Incompatible: ampicillin, amphotericin B, calcium gluconate 100 mg/mL (undiluted), cefotaxime, ceftazidime, cefuroxime, clindamycin, erythromycin, furosemide, piperacillin, SMOF
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