Bergner R et al. (2006) Fluconazole dosing in continuous veno-venous haemofiltration (CVVHF): need for a high daily dose of 800 mg. Nephrol Dial Transplant 21: 1019–1023
Fungal septicemia caused by Candida spp. is treated with fluconazole. In vitro testing of the effects of fluconazole on Candida spp. indicated that plasma levels of 16–32 µg/ml are necessary to inhibit growth of some Candida spp. effectively. In patients receiving continuous veno-venous hemofiltration or continuous veno-venous hemodialysis, trials of fluconazole infusions of 200–600 mg/day failed to reach the required plasma concentration. Researchers in Germany attempted to determine whether a fluconazole dose of 800 mg/day would produce the required plasma concentration in nine intensive-care patients receiving continuous veno-venous hemofiltration for acute renal failure.
Dialysis was carried out in two consecutive 24 h periods with an ultrafiltration rate of 1,000 ml/h on one day and a rate of 2,000 ml/h on the other, in a randomized order, with predilution of 800 ml/h and 1,800 ml/h, respectively. Peak fluconazole concentrations of 16–32 µg/ml were reached in all patients. Mean concentrations above 16 µg/ml were maintained for 17.0 ± 8.0 h at an ultrafiltration rate of 1,000 ml/h, and for 9.1 ± 8.3 h at an ultrafiltration rate of 2,000 ml/h. The treatment was well tolerated.
Although the in vivo concentration of fluconazole necessary for a therapeutic effect is not yet known, the study demonstrates that concentrations known to be effective against Candida spp. in vitro can be reached without adverse effects in critically ill patients.
Rights and permissions
About this article
Cite this article
Fluconazole dose of 800 mg daily is required to reach antifungal plasma levels. Nat Rev Nephrol 2, 351 (2006). https://doi.org/10.1038/ncpneph0207
Issue Date:
DOI: https://doi.org/10.1038/ncpneph0207