Teratogenicity of Fluconazole

To The Editors: Pursley et al.1 in February 1996 reported on three infants exhibiting congenital abnormalities after fluconazole was administered in the first trimester. This is the second report after that by Lees et al.2 in the Pediatric Infectious Disease Journal® on malformations in one infant born to a woman treated with fluconazole. We have administered fluconazole to a 24-year-old pregnant woman with shock, brain hemorrhage and Torulopsis glabrata fungemia in the 14th week of pregnancy (between first and second trimester), in dosages of 600 mg/day for 21 days. After successful treatment of fungemia (patient did not tolerate amphotericin B on the first day of therapy) and neurosurgical management of intracerebral hemorrhage (she was in shock for 10 days and on ventilatory support), the patient delivered spontaneously a healthy 2.95-kg baby in the 41st week. After 18 months of follow-up we have not observed any malformations or abnormalities in this child. Fluconazole was in contrast to previous reports administered to our patient in the 14th week, which is the early second trimester; however, the dosage was higher (600 μg intravenously) than that in reported cases (100 to 400 μg). We agree that fluconazole should generally not be administered in pregnancy; however, it will be interesting to have further reports to determine whether fluconazole is teratogenic not only in the first but also in the second (and third) trimesters. Vladimir Krcmery Jr., M.D.; Maria Huttova, M.D.; Oto Masar, M.D.