What is fluconazole used for
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Fluconazole: Uses and Applications
Introduction to Fluconazole
Fluconazole is a bis-triazole antifungal agent known for its high water solubility, low affinity for plasma proteins, and metabolic stability. It is widely used in the treatment and prophylaxis of various fungal infections, particularly in immunocompromised patients1 2 6.
Treatment of Candidiasis
Oropharyngeal and Esophageal Candidiasis
Fluconazole is highly effective in treating oropharyngeal and esophageal candidiasis, providing rapid relief and eradicating the yeast in 50 to 90% of patients2. It is particularly beneficial for patients with AIDS, where it serves as both treatment and secondary prophylaxis1 2.
Vaginal Candidiasis
For vaginal candidiasis, a single 150 mg oral dose of fluconazole achieves therapeutic concentrations in vaginal secretions, resulting in high clinical and mycological response rates. Clinical efficacy rates range between 92 and 99% shortly after treatment, and around 91% at 80 to 100 days post-treatment5 10.
Invasive Candidiasis
Fluconazole is a leading drug for the prevention and treatment of mucosal and invasive candidiasis. It is particularly effective in neutropenic patients undergoing chemotherapy or bone marrow transplantation3 4 7. However, it is important to note that Candida krusei is intrinsically resistant to fluconazole, and Candida glabrata often shows reduced susceptibility3.
Cryptococcal Meningitis
Fluconazole is a promising treatment for cryptococcal meningitis, especially in patients with AIDS. It resolves symptoms in up to 60% of patients and is the drug of choice for maintenance therapy following induction with amphotericin B1 2. Comparative trials have shown similar rates of clinical resolution and eradication of Cryptococcus neoformans from cerebrospinal fluid between fluconazole and amphotericin B2.
Prophylactic Use in High-Risk Patients
Cancer Patients
Fluconazole is effective as antifungal prophylaxis in cancer patients undergoing chemotherapy, radiotherapy, or immunotherapy. It significantly reduces the incidence of oral fungal diseases and is more effective than amphotericin B and nystatin in this context7.
Bone Marrow Transplantation
In patients undergoing bone marrow transplantation, fluconazole prophylaxis has been shown to reduce systemic fungal infections, superficial fungal infections, fungal colonization, and the need for empiric amphotericin B use. It also improves survival rates up to 110 days post-transplantation8 9.
Safety and Tolerability
Fluconazole is generally well-tolerated, with the most common adverse events being mild gastrointestinal symptoms, headache, and skin rash. Rare cases of exfoliative skin reactions and hepatic dysfunction have been reported, particularly in patients with AIDS1 2 5.
Conclusion
Fluconazole is a versatile and effective antifungal agent used in the treatment and prophylaxis of various fungal infections, particularly in immunocompromised patients. Its efficacy in treating candidiasis, cryptococcal meningitis, and its prophylactic use in high-risk patients underscores its importance in antifungal therapy. Despite the emergence of azole-resistant strains, fluconazole remains a first-line treatment option in many clinical scenarios.
Sources and full results
Most relevant research papers on this topic
Fluconazole. An update of its pharmacodynamic and pharmacokinetic properties and therapeutic use in major superficial and systemic mycoses in immunocompromised patients.
Fluconazole is an effective antifungal drug for treating fungal infections in patients with immune deficiencies, particularly in AIDS patients and those undergoing chemotherapy or bone marrow transplantation.
Fluconazole
Fluconazole shows promising results in treating various forms of candidiasis and cryptococcosis, with potential as a useful addition to current systemic antifungal therapies for patients with AIDS.
Literature Review
Highly CitedFluconazole for the management of invasive candidiasis: where do we stand after 15 years?
Fluconazole remains a first-line treatment option for invasive candidiasis, but its prophylactic use should be limited to selected high-risk patients to limit the risk of azole-resistant strains.
Literature ReviewHighly CitedProphylactic action of oral fluconazole against fungal infection in neutropenic patients
Oral fluconazole is effective in preventing fungal infections in neutropenic patients, with consistent results in studies involving chemotherapy-induced neutropenia.
Meta-AnalysisHighly CitedClinical Pharmacokinetics of Fluconazole
Fluconazole effectively treats various fungal infections, with a long elimination half-life and extensive distribution throughout the body, making it a useful drug for treating various systemic fungal infections.
Highly CitedEffectiveness of fluconazole as antifungal prophylaxis in cancer patients undergoing chemotherapy, radiotherapy, or immunotherapy: systematic review and meta‐analysis
Fluconazole is more effective in reducing oral fungal diseases during cancer treatment than amphotericin B and nystatin, but its effectiveness is low and very low.
Meta-AnalysisA randomized controlled trial of itraconazole versus fluconazole for the prevention of fungal infections in patients with haematological malignancies
Itraconazole oral solution has a better pharmacokinetic profile than fluconazole for antifungal prophylaxis in patients with haematological malignancies, offering better protection against fungal infections.
RCTHighly CitedEfficacy and safety of fluconazole prophylaxis for fungal infections after marrow transplantation--a prospective, randomized, double-blind study.
Fluconazole prophylaxis is safe and significantly reduces systemic fungal infections after marrow transplantation, with improved survival up to day 110.
RCT
Large Human TrialHighly Cited