Revisions for Fluconazole

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02-7-25 by ripal121

ripal121 replaced Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR with Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min. via Scanner Search and Replace module.

current revision
02-7-25 by ripal121

ripal121 replaced Intermittent HD with Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min. via Scanner Search and Replace module.

02-7-25 by conan.macdougal...

[email protected] replaced For detailed view of dialysis dosing and evidence, see <a href="https://idmp.ucsfsitebuilder.acsitefactory.com/content/ucsf-adult-antimicrobial-dosing-dialysis-reference-document">Dosing in Hemodialysis</a> document.</p> with via Scanner Search and Replace module.

11-25-24 by ripal121
11-25-24 by ripal121
04-24-24 by ripal121
10-5-23 by kaipe
10-5-23 by kaipe
08-2-21 by [email protected]
07-23-21 by conan.macdougal...
07-23-21 by conan.macdougal...
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06-29-21 by [email protected]
10-24-20 by conan.macdougal...
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10-16-20 by [email protected]
09-6-20 by conan.macdougal...
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07-10-20 by [email protected]
07-7-20 by [email protected]
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04-20-20 by ucsf_admin
04-20-20 by ucsf_admin
04-20-20 by ucsf_admin

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
Prophylaxis for Heme-BMT patients 400 mg PO/IV q24h 50% of target dose IV/PO q24h 25% of target dose IV/PO q24h

*Higher doses may be necessary in some circumstances such as obese patients with severe infections

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

Prophylaxis for Heme-BMT patients 200 mg IV/PO x1 then post-HD 400 mg IV/PO q 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

References: