Continuation therapy for candidaemia
If the Candida isolate is identified as fluconazole-susceptible and the patient is not critically ill, change initial therapy to fluconazole. For adults and children 1 month or older who are clinically stable (eg afebrile for more than 24 hours, have cleared Candida from the bloodstream, able to tolerate oral therapy), oral fluconazole may be used initially instead of intravenous fluconazole (see dosage below). For neonates, intravenous therapy should be used for the duration of continuation therapy (see dosage below).
For continuation therapy for candidaemia in adults and children 1 month or older, if intravenous therapy is indicated, use:
fluconazole 800 mg (child: 12 mg/kg up to 800 mg) intravenously, for the first dose1, then 400 mg (child: 6 mg/kg up to 400 mg) intravenously, daily. For dosage adjustment in adults with kidney impairment, see fluconazole dosage adjustment. Following clinical improvement, continue therapy with oral fluconazole (see dosage below). fluconazole fluconazolefluconazole
For oral continuation therapy for candidaemia in adults and children 1 month or older, useKeighley, 2021:
fluconazole 800 mg (child: 12 mg/kg up to 800 mg) orally, for the first dose1, then 400 mg (child: 6 mg/kg up to 400 mg) orally, daily. For dosage adjustment in adults with kidney impairment, see fluconazole dosage adjustment. See advice on duration of therapy for candidaemia. fluconazole fluconazole fluconazole
For adults with organ dysfunction or obesity (body mass index [BMI] of 30 kg/m2 or more), higher maintenance doses of fluconazole (eg 6 mg/kg daily) may be required. If the Candida isolate is reported to have dose-dependent susceptibility to fluconazole (ie susceptible dose dependent [SDD] or susceptible increased exposure [I or SIE]), maintenance doses up to 12 mg/kg daily may be required – seek expert adviceBoonstra, 2021Sandaradura, 2021. If higher doses of fluconazole are used, therapeutic drug monitoring may be required; for more information, see Monitoring antifungal blood concentrations.
For continuation therapy for candidaemia in neonates, useKeighley, 2021:
fluconazole 25 mg/kg intravenously, for the first dose1, then 12 mg/kg intravenously, daily. See advice on duration of therapy for candidaemia. fluconazole fluconazole fluconazole
For continuation therapy for fluconazole-resistant Candida species, seek expert advice.