Fluconazole

Dosing: Adult Antimicrobial Dosing, Non-dialysis

Indication CrCl > 50 mL/min CrCl 10 - 50 mL/min CrCl < 10 mL/min
Oropharyngeal Infection 100 mg IV/PO q24h 50% of target dose IV/PO q24h 25% of target dose IV/PO q24h
Esophageal Infection 200 mg IV/PO q24h 50% of target dose IV/PO q24h 25% of target dose IV/PO q24h
Systemic/Severe Infections*

≤ 80 kg: 400mg IV/PO q24h

81 – 100 kg: 600 mg IV/PO q24h

> 100 kg: 800 mg IV/PO q24h

50% of target dose IV/PO q24h

25% of target dose IV/PO q24h

*Higher doses may be necessary in some circumstances

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis

Indication Intermittent Hemodialysis Continuous Hemodialysis*
Oropharyngeal Infection 100 mg IV/PO x1 now, then post-HD 200 mg IV/PO q24h
Esophageal Infection 200 mg IV/PO x1 now, then post-HD 400 mg IV/PO q24h
Severe Infections

400 mg IV/PO x1 now, then post-HD

 

800-1200 mg IV/PO per day, divided q12-24h

*Data suggests that fluconazole clearance in patients receiving CVVHD is higher than in patients with normal renal function, necessitating use of higher dosing. These recommendations have not been evaluated for other continuous renal replacement modalities (ex. CVVH) and may not apply. 

Dialysis Notes

Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.  For detailed view of dialysis dosing and evidence, see Dosing in Hemodialysis document.

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