Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

6. Prophylaxis of fungal infections in adult and pediatric patients undergoing chemotherapy or allogenic bone marrowtransplantation (400 mg daily), and sometimes high risk liver transplant patients.7. Vaginal yeast infection due to Candida, in immunocompetent patients, (150 mg PO as a single dose).8. Candiduria. Treatment is only indicated in symptomatic patients or in asymptomatic patients who areimmunocompromised or have a urinary tract obstruction. Lower doses may be used (100 mg PO day 1, then 50 mg POdaily). Urinary catheter should be removed to prevent relapses.CommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect.Chronic therapy is often required for AIDS patients and may be required for recurrent oropharyngeal candidiasis.Resistance has been reported in patients treated with prolonged or multiple courses of fluconazole.Oral therapy is bioequivalent to IV therapy, and IV should be reserved for those patients who cannot tolerate oralmedications.See IV-to-PO conversion policy (Appendix F) or on uconnect.See Guidelines for Use of Antifungal Agents (Appendix E) or on uconnect.NOTE: Prompt removal of intravenous catheters is essential to improve outcomes in patients with systemic catheterrelatedfungal infections, especially in patients who are neutropenic or are receiving combination antimicrobials.Drug InteractionsFluconazole inhibits drug metabolism because of inhibition of the cytochrome P450 isoenzymes 2C9 and 3A4; patientsshould be monitored for drug interactions. Some drugs that may have increased levels when administered concomitantlywith fluconazole due to 2C9 inhibition are:• Bosentan• Celecoxib• Ramelteon• WarfarinSome drugs that may have increased levels when administered concomitantly with fluconazole due to 3A4 inhibition are:• Benzodiazepines • HMG-CoA reductase inhibitors• Carbamazepine • Methadone• Cyclosporine • Prednisone• Dihydropyridine calcium channel blockers • Rifabutin• Eplerenone • Sirolimus• Ergot derivatives • Tacrolimus• Everolimus • Tipranivir• Fentanyl • Triptans• Ixabepilone • ZidovudineFluconazole may prolong the QT interval, an effect that may be additive with the QT-prolonging effects of many drugsincluding the following:• Anti-emetics • Class III anti-arrhythmic drugs• Antipsychotic drugs • Fluoxetine• Arsenic trioxide • Fluoroquinolones• Astemizole (contraindicated) • Telithromycin• Chloral hydrate • Terfenadine (contraindicated)• Chloroquine • Tricyclic antidepressants• Cisapride• Class Ia anti-arrhythmic drugsOther drugs that interact with fluconazole include the following:• Cimetidine – reduced oral absorption of fluconazole• Nevirapine – levels increased• Nitrofurantoin – levels increased