To : Diane
Re : Diflucan and yeast


The dose of Diflucan I routinely suggest to physicians and patients is still
200 mg STAT followed by 100 mg daily for mucocutaneous candidiasis.  I know
others use twice this dose (certain Canadian experts), but studies in the
USA seem to suggest that Candida albicans is still pretty sensitive to
fluconazole and this dose is still recommended by the infectious disease
experts and the package insert.

As for duration, that depends on the site of infection.  The package insert
information is published in my book.  For what we are calling 'ductal
candidiasis' 2-3 weeks is generally considered requisite.

As for this patient, we know that several very resistant Candia species are
beginning to arise.  This mom may need a vaginal culture to see which strain
of candida she really has. Some of them are difficult to eradicate...and the
strain is very important in understanding this.

Nystatin cream is virtually worthless anymore, and most of my pediatric
faculty and residents now use the other azole antifungal creams(miconazole,
clotrimazole) instead.

As for the statment that "Tom Hale recommends up to 12 weeks on 200 mg/day
if yeast recurs after initial 400 mg loading dose and 28 days of 200
mg/day."    Twelve weeks of therapy is the dose recommended for cryptococcal
meningitis acute" from the manufacturers package insert.  This is not the
dose for mucocutaneous, or vaginal, or ductal candidiasis.  Lets be clear on
this.

I think the best thing for this mom is to see if she can get a really good
culture of this yeast, and identify the strain.

Should it be candida albicans, then perhaps she could use the one dose per
week method used in immunocompromized individuals.

Regards

Tom Hale, PH.D.

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