Fluconazol

[Oshgosh]

Hello has anyone had Fluconazole prescribed for a fungal lung infection. I have just finished a 2 week course.

[Hidden]

Bod had a 3 week course of this last year. Anything in particular you wanted to know?

[Oshgosh]

Thanks for your reply. My shortness of breath has increased o er the last 3 months.

I wondered if the fluconazole would help my breathing.did it help you ?

[Hidden in reply to Oshgosh]

Well, fluconazole is an antifungal, so it will only help if the root cause of your symptoms is a fungal infection, and one that’s sensitive to that drug. Have you cultured a fungus recently?

For us it was a minor step in the right direction. Bod had been really bad with her chest since the March, had had several courses of IVs with no real impact, and was given the fluconazole in the August because I suspected it could be a fungal issue, and her new team (we’d just moved 250 miles at this point, in the hopes of accessing better medical care) were very concerned about her and had no better ideas. At the time, she hadn’t had a positive culture for fungi, but she had been routinely growing candida albicans for a couple of years. Fluconazole is the drug of choice for candida, so the thought process was that if it was a genuine candida lung infection, rather than being an airway colony as is usually the case when it shows up regularly, the fluconazole would help. We did see some minor improvement alongside almost a month of inpatient treatment, but nothing dramatic. To cut a long story short, because we’d seen some change, the next time she went in for IVs they gave her a 4 week course of posaconazole, which is a much stronger and broader acting anti-fungal, and the improvement was incredible. Her chest dried up massively, the colour of what she was clearing improved tenfold, the wheezing she’d had for 7 months completely disappeared, as did her breathlessness, and we saw an almost 15% increase in fev1. Subsequent to that, it turned out she’d cultured a fungus called exophiala dermatitidis just before we put her on the posa, proving that fungus was indeed the issue all along.

She was really good for about 2 months post the posa, but then began to slowly slide back again from Feb this year onwards. Having stamped my feet a bit, they gave her another short course in April, which again improved things (although not as much as last time) and that was enough to satisfy them that fungal issues remained, particularly when another 4 week fungal culture eventually came back positive for e.dermatitidis again. When she went in for IVs in May they gave her a 10 day course of IV amphotericin, which is the strongest possible option for fungus, and said they were hopeful that they could still eradicate it despite the fact it’d been present for over 12 months at that point. We now just have to wait and see how things go in the longer term, but they have given us a 2 week course of posa to keep in the cupboard alongside her rescue antibiotics and steroids.

[Oshgosh in reply to Hidden]

Thanks for the information,

What did bother me was that the GP didn’t seem to think it was a problem,didn’t want to prescribe.

Rheumatologist and ILD consultants wanted me on anti fungal ,so just finished 2 weeks course of FluconaZole.

So feel a bit better ,no sore mouth,ulcers etc .

Shortness of breath persists,but as you say we have to wait and see.

It’s difficult because it’s hard to know which condition is causing what.

I’m lucky in that we only live 40 minutes drive from where I’m treated. The teams who deal with me are very honest,which helps a lot.thanks for you post,am trying to save it for future reference.

[Hidden in reply to Oshgosh]

With the utmost respect to GPs, they are the mainstay of the nhs and know a little bit about lots of things, but they’re not an expert in anything, and particularly not when it comes to the management of complex, chronic conditions. The best GPs are the ones that recognise that’s the case, broadly educate themselves around specific conditions if they have a patient with one, but ultimately listen to the specialists. The reality is that I would quite happily stake my life savings on knowing more about my daughter’s respiratory condition than 99% of GPs and a fairly decent proportion of hospital docs, too. It always amazes me when the hospital write to our GP, and then someone somewhere in the practice decides that the dosages of medication or the directions to take them the letter states can’t possibly be right, so they change them, and I then have terrible problems trying to get it rectified again. In our case, the GP’s only job is to print out the child’s prescription, that’s literally it, but they rarely do that without fiddling with something, and that’s despite the two doctors I choose to interact with at the practice being extremely good.

From what I know and understand, if the breathlessness is persisting in spite of trying all the usual measures, there’s no harm in trying an antifungal: resistance is nowhere near as big a problem with fungi as it is with bacteria, so the worst that can happen is that it doesn’t help, and they must think there’s sufficient reason to try it or they wouldn’t bother. I do wonder if fluconazole is the best option though, as the kind of fungi that really cause breathlessness and respiratory issues are primarily things like Aspergillus. That said, there are blood tests that can identify exposure to Aspergillus and whether or not you have an allergy to it, and I suspect (and hope!) you would have had those as it’s an easier first step when looking at fungus as a potential cause of breathlessness. We opted for fluconazole first because we thought the yeast could be the issue and it was the most appropriate drug choice for that. Do you know if the GP choose which antifungal to give you, or did the consultants specifically request that you have fluconazole?

Unfortunately, if you’ve finished the course and there’s been little or no improvement, my understanding is that it’s unlikely to improve any further now that you’ve stopped taking it. They’re a lot like antibiotics in that regard. All that said, though, you mentioned a sore mouth/mouth ulcers: were you suffering with those and they’ve now cleared? If that’s the case, the fluconazole may actually have been prescribed to treat that, as candida causes fungal infections of the mouth, which can lead to sores, ulcers and itching.

Anyway, I hope some of that was useful, and that you get some answers soon.

[Oshgosh in reply to Hidden]

Thank You