抄録
To evaluate the optimal dosage for fluconazole based on the pharmacokinetics, we monitored the serum fluconazole concentrations in seventy-seven inpatients who received a fixed maintenance dose of fluconazole for at least 7 days. A significant negative and a positive correlation were obtained between the C/D ratio (trough concentration/dose/body weight) and the creatinine clearance (Ccr; r2=0.287), and the C/D and the urea nitrogen (BUN; r2=0.234), respectively. No significant correlation was obtained between the C/D and age (r2=0.0232). There was no difference in the C/D between patients receiving medication intravenously and orally (p=0.635). The relationships between the dosage and serum trough concentration were as follows : Ccr≥50 group : y=3.54x-1.07 (r2=0.877), Ccr<50 group : y =3.59x+8.20 (r2=0.504). About 50% decrease in serum fluconazole concentration was observed in patients received hemodialysis (HD) therapy. No significant difference was observed in the C/D between patients received CHDF therapy and patients whose Ccr above 50 mL/min (p=0.263). These results suggest the following conclusions :
1 The optimal dosage of fluconazole is 5-10mg/kg/day in patients whose Ccr are above 50mL/min.
2 TDM is needed in patients with decreased renal function.
3 A higher dosage of fluconazole is needed to maintain the therapeutic level in patients undergoing HD or CHDF.
