Fluconazole observational studies

Because C. glabrata often has reduced susceptibility to both fluconazole and amphotericin B, optimal therapy is unclear. Larger doses of fluconazole (800 mg/day in a 70-kg patient) have been used in less critically ill patients or amphotericin B (>0.7 mg/kg per day). However, recent observational studies demonstrated no difference in mortality in nonneutropenic patients administered fluconazole versus amphotericin B for bloodstream infections caused by C. glabrata. The potential utility of caspofungin has not been assessed. ... 

Most clinicians recommend amphotericin B in total dosages of 0.5-1 g administered over approximately 1 to 2 weeks in patients with Candida endophthalmitis and in all neutropenic patients with candidemia. " Longer courses of therapy may be needed in some patients. Observational studies suggest that fluconazole and amphotericin B are similarly effective for the treatment of C. albicans bloodstream infections in the neutropenic patient controlled data, however. 

Observational studies Fluconazole is increasingly used to treat fungal infections in neonatal and paediatric populations. Common adverse reactions described include hepatotoxicity and gastrointestinal symptoms, but these two have not been thoroughly evaluated in neonates and other paediatric age groups. 

Three large randomized studies in nonneutropenic patients have demonstrated that fluconazole at 400 mg/day and deoxycholate amphotericin B at 0.5-0.6 mg/kg per day are similarly effective however, fewer adverse effects are observed with fluconazole therapy." " Similarly, caspofungin is at least as effective as amphotericin B 0.6-0.7 mg/kg per day in (mainly nonneutropenic) adult patients with candidemia with fewer drug-related adverse events. Although the use of combination therapy (high-dose fluconazole plus amphotericin B) was demonstrated recently to be superior to treatment with fluconazole alone, the routine use of combination therapy in this patient population is not yet recommended." " Neonates with disseminated... 

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