Definition and research guide
This page combines a MeSH definition, publication statistics and selected research abstracts. It is a starting point for reading the literature, not a medical textbook or a systematic evidence review.
Content available: 4 complete abstracts (881 words), 10 references. Full article text is not stored or reproduced here; follow the PMID, DOI or PMC links to read the original sources and their access terms.
Definition
Triazole antifungal agent that is used to treat oropharyngeal candidiasis and cryptococcal meningitis in AIDS.
Definition: NLM Medical Subject Headings (MeSH) scope note (Public domain (U.S. National Library of Medicine); attribution requested). View the MeSH record.
Also known as: Diflucan; UK-49858; UK49858; UK 49858; Apo-Fluconazole; Apo Fluconazole; Béagyne; Fluc Hexal.
Where it fits in the MeSH classification
- Broader topics
- Triazoles
Related concepts
- Candidiasis
- Meningitis
Research landscape
PubMed indexes 9,701 records tagged with the MeSH heading “Fluconazole” (counts retrieved 2026-10-31). 1,954 of them (20.1%) were published from 2020 onward, and the busiest period so far is 2010-2019 with 2,853 records.
Reviews account for 931 records (9.6%) and meta-analyses for 106. Randomized controlled trials number 469 (4.8%) as a share of all records on the topic.
Show the data
| Period | Records |
|---|---|
| through 1999 | 2,331 |
| 2000-2009 | 2,563 |
| 2010-2019 | 2,853 |
| 2020 onward | 1,954 |
Publication-type chart data
| Type | Records | Share |
|---|---|---|
| Reviews | 931 | 9.6% |
| Meta-analyses | 106 | 1.1% |
| Randomized controlled trials | 469 | 4.8% |
Method: PubMed query "Fluconazole"[MeSH Terms] with publication-type and date filters, retrieved 2026-10-31.
Reading the evidence in drugs and chemicals
Studies of a chemical or drug can answer very different questions: what it is and how it behaves in cells and animals, how the body handles it, and whether it changes outcomes in people. Laboratory and animal findings often do not carry over to patients, and observational studies of exposures are confounded by who uses a substance and why. Nothing on this page is a recommendation to use, avoid, start or stop any substance or medicine; talk to a qualified clinician or pharmacist about your own situation. Check the dose, the species, the comparison group and whether a patient-relevant outcome was measured.
Evidence from open-access studies
These open-access studies come from PubMed’s best-match results for this heading (papers whose main topic it is), ranked here by citation count, with one recent addition. Each abstract is reproduced in full under its recorded open licence so that you can read the authors’ own words. They illustrate the literature; they are not a systematic summary of it. Citation counts measure attention, not reliability or clinical benefit.
| Study / authors | Year | Source label / design | Europe PMC citations | Licence / source |
|---|---|---|---|---|
| Antifungal tolerance is a subpopulation effect distinct from resistance and is associated with persistent candidemia | 2018 | Research article Design not recorded in structured metadata | 255 | cc by PMID 29941885 · DOI · PMC6018213 |
| Single-Dose Liposomal Amphotericin B Treatment for Cryptococcal Meningitis | 2022 | Randomized controlled trial Design not recorded in structured metadata | 239 | cc by PMID 35320642 · DOI · PMC7612678 |
| Dynamic ploidy changes drive fluconazole resistance in human cryptococcal meningitis | 2019 | Research article Design not recorded in structured metadata | 157 | cc by PMID 30688656 · DOI · PMC6391087 |
| Rezafungin in fluconazole-resistant and refractory candidiasis: the first Brazilian experience | 2026 | Research article Design not recorded in structured metadata | 0 | cc by PMID 41711929 · DOI · PMC12919916 |
Antifungal tolerance is a subpopulation effect distinct from resistance and is associated with persistent candidemia [1]
Abstract reading summary — source excerpts
- Opening excerpt
- Tolerance to antifungal drug concentrations above the minimal inhibitory concentration (MIC) is rarely quantified, and current clinical recommendations suggest it should be ignored.
- Closing excerpt
- Thus, tolerance correlates with, and may help predict, patient responses to fluconazole therapy.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (158 words)
Tolerance to antifungal drug concentrations above the minimal inhibitory concentration (MIC) is rarely quantified, and current clinical recommendations suggest it should be ignored. Here, we quantify antifungal tolerance in Candida albicans isolates as the fraction of growth above the MIC, and find that it is distinct from susceptibility/resistance. Instead, tolerance is due to the slow growth of subpopulations of cells that overcome drug stress more efficiently than the rest of the population, and correlates inversely with intracellular drug accumulation. Many adjuvant drugs used in combination with fluconazole, a widely used fungistatic drug, reduce tolerance without affecting resistance. Accordingly, in an invertebrate infection model, adjuvant combination therapy is more effective than fluconazole in treating infections with highly tolerant isolates and does not affect infections with low tolerance isolates. Furthermore, isolates recovered from immunocompetent patients with persistent candidemia display higher tolerance than isolates readily cleared by fluconazole. Thus, tolerance correlates with, and may help predict, patient responses to fluconazole therapy.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 29941885 · DOI · PMC6018213
Single-Dose Liposomal Amphotericin B Treatment for Cryptococcal Meningitis [2]
Abstract reading summary — source excerpts
- Opening excerpt
- BackgroundCryptococcal meningitis is a leading cause of human immunodeficiency virus (HIV)-related death in sub-Saharan Africa.
- Closing excerpt
- ).
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (318 words)
BackgroundCryptococcal meningitis is a leading cause of human immunodeficiency virus (HIV)-related death in sub-Saharan Africa. Whether a treatment regimen that includes a single high dose of liposomal amphotericin B would be efficacious is not known.MethodsIn this phase 3 randomized, controlled, noninferiority trial conducted in five African countries, we assigned HIV-positive adults with cryptococcal meningitis in a 1:1 ratio to receive either a single high dose of liposomal amphotericin B (10 mg per kilogram of body weight) on day 1 plus 14 days of flucytosine (100 mg per kilogram per day) and fluconazole (1200 mg per day) or the current World Health Organization-recommended treatment, which includes amphotericin B deoxycholate (1 mg per kilogram per day) plus flucytosine (100 mg per kilogram per day) for 7 days, followed by fluconazole (1200 mg per day) for 7 days (control). The primary end point was death from any cause at 10 weeks; the trial was powered to show noninferiority at a 10-percentage-point margin.ResultsA total of 844 participants underwent randomization; 814 were included in the intention-to-treat population. At 10 weeks, deaths were reported in 101 participants (24.8%; 95% confidence interval [CI], 20.7 to 29.3) in the liposomal amphotericin B group and 117 (28.7%; 95% CI, 24.4 to 33.4) in the control group (difference, -3.9 percentage points); the upper boundary of the one-sided 95% confidence interval was 1.2 percentage points (within the noninferiority margin; P10 colony-forming units (CFU) per milliliter per day in the liposomal amphotericin B group and -0.42 log10 CFU per milliliter per day in the control group. Fewer participants had grade 3 or 4 adverse events in the liposomal amphotericin B group than in the control group (50.0% vs. 62.3%).ConclusionsSingle-dose liposomal amphotericin B combined with flucytosine and fluconazole was noninferior to the WHO-recommended treatment for HIV-associated cryptococcal meningitis and was associated with fewer adverse events. (Funded by the European and Developing Countries Clinical Trials Partnership and others; Ambition ISRCTN number, ISRCTN72509687.).
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 35320642 · DOI · PMC7612678
Dynamic ploidy changes drive fluconazole resistance in human cryptococcal meningitis [3]
Abstract reading summary — source excerpts
- Opening excerpt
- BackgroundCryptococcal meningitis (CM) causes an estimated 180,000 deaths annually, predominantly in sub-Saharan Africa, where most patients receive fluconazole (FLC) monotherapy.
- Closing excerpt
- FundingThis work was supported by the Wellcome Trust Strategic Award for Medical Mycology and Fungal Immunology 097377/Z/11/Z and the Daniel Turnberg Travel Fellowship.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (305 words)
BackgroundCryptococcal meningitis (CM) causes an estimated 180,000 deaths annually, predominantly in sub-Saharan Africa, where most patients receive fluconazole (FLC) monotherapy. While relapse after FLC monotherapy with resistant strains is frequently observed, the mechanisms and impact of emergence of FLC resistance in human CM are poorly understood. Heteroresistance (HetR) - a resistant subpopulation within a susceptible strain - is a recently described phenomenon in Cryptococcus neoformans (Cn) and Cryptococcus gattii (Cg), the significance of which has not previously been studied in humans.MethodsA cohort of 20 patients with HIV-associated CM in Tanzania was prospectively observed during therapy with either FLC monotherapy or in combination with flucytosine (5FC). Total and resistant subpopulations of Cryptococcus spp. were quantified directly from patient cerebrospinal fluid (CSF). Stored isolates underwent whole genome sequencing and phenotypic characterization.ResultsHeteroresistance was detectable in Cryptococcus spp. in the CSF of all patients at baseline (i.e., prior to initiation of therapy). During FLC monotherapy, the proportion of resistant colonies in the CSF increased during the first 2 weeks of treatment. In contrast, no resistant subpopulation was detectable in CSF by day 14 in those receiving a combination of FLC and 5FC. Genomic analysis revealed high rates of aneuploidy in heteroresistant colonies as well as in relapse isolates, with chromosome 1 (Chr1) disomy predominating. This is apparently due to the presence on Chr1 of ERG11, which is the FLC drug target, and AFR1, which encodes a drug efflux pump. In vitro efflux levels positively correlated with the level of heteroresistance.ConclusionOur findings demonstrate for what we believe is the first time the presence and emergence of aneuploidy-driven FLC heteroresistance in human CM, association of efflux levels with heteroresistance, and the successful suppression of heteroresistance with 5FC/FLC combination therapy.FundingThis work was supported by the Wellcome Trust Strategic Award for Medical Mycology and Fungal Immunology 097377/Z/11/Z and the Daniel Turnberg Travel Fellowship.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 30688656 · DOI · PMC6391087
Rezafungin in fluconazole-resistant and refractory candidiasis: the first Brazilian experience [4]
Abstract reading summary — source excerpts
- Opening excerpt
- Invasive candidiasis is associated with high morbidity and mortality, and the rising of antifungal resistance underscores the need for new therapies.
- Closing excerpt
- These are the first documented cases of rezafungin use for invasive candidiasis in Brazil.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (100 words)
Invasive candidiasis is associated with high morbidity and mortality, and the rising of antifungal resistance underscores the need for new therapies. Rezafungin, a second-generation echinocandin, enables once-weekly dosing, achieves high plasma concentrations, and shows potent in vitro activity. We report two Brazilian cases showing its clinical utility: (i) fluconazole-resistant Candida tropicalis bloodstream infection in a patient with colorectal cancer and chronic kidney disease and (ii) azole-refractory C. albicans esophagitis in a patient with autoimmune polyglandular syndrome type 1. Both achieved rapid clinical response and microbiological clearance. These are the first documented cases of rezafungin use for invasive candidiasis in Brazil.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 41711929 · DOI · PMC12919916
Key reviews and meta-analyses
The most cited review-type papers among PubMed’s best-match results for this heading, listed with bibliographic details only. Follow the links for the full text and access terms.
- Research article Development of interpretive breakpoints for antifungal susceptibility testing: conceptual framework and analysis of in vitro-in vivo correlation data for fluconazole, itraconazole, and candida infections. Subcommittee on Antifungal Susceptibility Testing of the National Committee for Clinical Laboratory Standards [5]
- Research article Resistance of Candida species to fluconazole [6]
- Research article Pharmacokinetics and tissue penetration of fluconazole in humans [7]
- Research article Fluconazole. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in superficial and systemic mycoses [8]
- Research article Twelve years of fluconazole in clinical practice: global trends in species distribution and fluconazole susceptibility of bloodstream isolates of Candida [9]
- Research article Worldwide emergence of fluconazole-resistant Candida parapsilosis: current framework and future research roadmap [10]
References
- Rosenberg A, Ene IV, Bibi M, Zakin S, Segal ES, Ziv N, et al.. Antifungal tolerance is a subpopulation effect distinct from resistance and is associated with persistent candidemia. . 2018. PMID 29941885 · DOI · PMC6018213
- Jarvis JN, Lawrence DS, Meya DB, Kagimu E, Kasibante J, Mpoza E, et al.. Single-Dose Liposomal Amphotericin B Treatment for Cryptococcal Meningitis. . 2022. PMID 35320642 · DOI · PMC7612678
- Stone NR, Rhodes J, Fisher MC, Mfinanga S, Kivuyo S, Rugemalila J, et al.. Dynamic ploidy changes drive fluconazole resistance in human cryptococcal meningitis. . 2019. PMID 30688656 · DOI · PMC6391087
- Kruschewsky WLL, Nakagawa JAS, Siqueira LPM, Taborda M, de Oliveira VF, Abdala E, et al.. Rezafungin in fluconazole-resistant and refractory candidiasis: the first Brazilian experience. . 2026. PMID 41711929 · DOI · PMC12919916
- Rex JH, Pfaller MA, Galgiani JN, Bartlett MS, Espinel-Ingroff A, Ghannoum MA, et al.. Development of interpretive breakpoints for antifungal susceptibility testing: conceptual framework and analysis of in vitro-in vivo correlation data for fluconazole, itraconazole, and candida infections. Subcommittee on Antifungal Susceptibility Testing of the National Committee for Clinical Laboratory Standards. Clin Infect Dis. 1997. PMID 9114154 · DOI
- Rex JH, Rinaldi MG, Pfaller MA. Resistance of Candida species to fluconazole. Antimicrob Agents Chemother. 1995. PMID 7695288 · DOI · PMC162475
- Brammer KW, Farrow PR, Faulkner JK. Pharmacokinetics and tissue penetration of fluconazole in humans. Rev Infect Dis. 1990. PMID 2184510 · DOI
- Grant SM, Clissold SP. Fluconazole. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in superficial and systemic mycoses. Drugs. 1990. PMID 2196167 · DOI
- Pfaller MA, Diekema DJ, International Fungal Surveillance Participant Group. Twelve years of fluconazole in clinical practice: global trends in species distribution and fluconazole susceptibility of bloodstream isolates of Candida. Clin Microbiol Infect. 2004. PMID 14748799 · DOI
- Daneshnia F, de Almeida Júnior JN, Ilkit M, Lombardi L, Perry AM, Gao M, et al.. Worldwide emergence of fluconazole-resistant Candida parapsilosis: current framework and future research roadmap. Lancet Microbe. 2023. PMID 37121240 · DOI · PMC10634418
About this article
- Sources
- NLM Medical Subject Headings (definition, synonyms); NCBI PubMed (counts, identifiers); Europe PMC (open-access abstracts and citation counts).
- Verification
- Every reference was resolved against PubMed on 2026-10-31; title, year and DOI matched.
- Review state
- automated source verified; no human expert review has been recorded yet.
- Version
- 1, last updated 2026-10-31.
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Evidence strength
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