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Fluconazole is a triazole antifungal medication used to treat or prevent severe fungal infections in patients who have developed resistance to other antifungal drugs, are recuperating from bone marrow or other transplant procedures, or are more susceptible to fungal infections due to immune deficiencies from cancer and radiation treatments or as part of their Human Immunodeficiency Virus (HIV) regimen.
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Fluconazole is a potent inhibitor of cytochrome P450 (CYP) isoenzyme 2C9 and 2C19, and a moderate inhibitor of CYP3A4.
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In most of these patients, use IV voriconazole initially; consider transitioning to oral voriconazole only after patient is clinically stable or improving and consider initial treatment with oral voriconazole only in those with mild disease who can be monitored closely.
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The United Kingdom's has stated that "most isolates with NDM-1 enzyme are resistant to all standard intravenous antibiotics for treatment of severe infections.
Clinical signs of disseminated disease may include skin lesions described as painless, erythematous, pustular to macronodular lesions.
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For treatment of candidemia in nonneutropenic patients or for empiric treatment of suspected invasive candidiasis in nonneutropenic patients, IDSA recommends fluconazole or an echinocandin (caspofungin, micafungin, anidulafungin) for initial therapy; amphotericin B (conventional or lipid formulation) is an alternative when these drugs have been ineffective or cannot be used because of intolerance or resistance.
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Recommended as alternative therapy for severe nonmeningeal infection; some experts add a triazole to amphotericin B (preferred therapy) and continue the triazole after amphotericin B is stopped.
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In another report, the combination of caspofungin and liposomal amphotericin was utilized as salvage therapy in patients who had an inadequate response to liposomal amphotericin monotherapy or as primary therapy ().
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