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Fluconazole / Diflucan

- Discussion:
- for treatment of Candida infections;
    - bioavailability of orally administered fluconazole is over 90% compared with intravenous administration
    - dose 200 to 400 mg per day

- Cautions:
    - Dosing Regimens for Patients w/ Renal Insufficiency:
              (Dose for 70 kg Adult (gm/dosing interval in hours) CrCl:>80: 0.1-0.2/24; CrCl: 50-79: 0.1-0.2/24; CrCl: 30-49: 0.05-0.1/24; CrCl:10-29: 0.025-0.05/24;
    - 80 % of dose will be excreted in urine (w/ nl R F(x))
    - Will falsely incr Serum Cr;
    - Will increase effect of warfarin;
    - Ratio of CSF to Blood Level (%): Nl Meninges: 70-80; Inflammed: > 70-80

References for Fluconazole:

   - A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. Candidemia Study Group and the National Institute. 
   - In vitro analysis of antifungal impregnated polymethylmethacrylate bone cement.
   - Successful 1-stage exchange total knee arthroplasty for fungal infection. 
   - Candida arthritis after total knee arthroplasty--a case of successful treatment without prosthesis removal
   - Candida albicans prosthetic arthritis treated with fluconazole alone.
   - Fungal arthritis--a rare complication of systemic candidiasis or orthopedic intervention. Review of therapeutic experience with fluconazole  
   - Micafungin plus fluconazole in an infected knee with retained hardware due to Candida albicans.
   - Microbiological, clinical, and surgical features of fungal prosthetic joint infections: a multi-institutional experience
   - Synovial fluid levels of fluconazole in a patient with Candida parapsilosis prosthetic joint infection who had an excellent clinical response

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