Single-phase antifungal therapy for cryptococcosis

Chang 2021

Single-phase fluconazole therapy can be used in patients with nonsevere pulmonary cryptococcosis (eg single pulmonary cryptococcoma, minimal symptoms), if extrapulmonary disease has been excluded. In patients with immune compromise who have nonsevere infection, some experts recommend more aggressive therapy (3-phase therapy) regardless of whether there is extrapulmonary involvement – seek expert advice.

In adults and children with cryptococcosis, if single-phase fluconazole therapy is appropriate, useChang 2021:

fluconazole 400 mg (child: 6 mg/kg up to 400 mg) orally, daily. Continue for 6 to 12 months, or if immunosuppressed, as long as immunosuppression continues. For dosage adjustment in adults with kidney impairment, see fluconazole dosage adjustment. fluconazole fluconazole fluconazole

In most patients, fluconazole at the dosage above, is suitable for single-phase antifungal therapy. Higher doses may be required:

  • for heavier patients (eg BMI 30 kg/m2 or more)
  • when the fluconazole minimum inhibitory concentration (MIC) is elevated (eg 8 mg/L).

If a higher dose of fluconazole is required for single-phase antifungal therapy, use:

fluconazole 800 mg (child: 12 mg/kg up to 800 mg) orally, daily. Continue for 6 to 12 months, or if immunosuppressed, as long as immunosuppression continues. For dosage adjustment in adults with kidney impairment, see fluconazole dosage adjustment. fluconazole fluconazole fluconazole

Consider therapeutic drug monitoring if the higher fluconazole dose (800 mg) is used. Fluconazole can cause nausea at higher doses.

If oral single-phase antifungal therapy is not tolerated, useChang 2021:

1fluconazole 400 mg (child: 6 mg/kg up to 400 mg) intravenously, daily. For dosage adjustment in adults with kidney impairment, see fluconazole dosage adjustment. Switch to oral fluconazole (see dosage above) when possible fluconazole fluconazole fluconazole

OR if the higher fluconazole dose is required (see above)

1fluconazole 800 mg (child: 12 mg/kg up to 800 mg) intravenously, daily. For dosage adjustment in adults with kidney impairment, see fluconazole dosage adjustment. Switch to oral fluconazole (see dosage above) when possible. fluconazole fluconazole fluconazole