fluconazole

Context

Pharmacy First

Inclusion/exclusion criteria

We included codes representing fluconazole as a virtual therapeutic moiety (VTM) and all corresponding medicinal products (VMPs) where fluconazole is the active ingredient. This includes oral capsules, oral suspension, formulations across all available strengths within the Dictionary of Medicines and Devices (dm+d).

We also included combination products containing fluconazole where it is co-packaged with clotrimazole for the treatment of vulvovaginal candidiasis. These include fluconazole 150mg capsule combined with clotrimazole cream products (both 1% and 2% formulations), as well as their associated AMP entries (e.g. Boots Pharmacy Thrush Duo and Canesten Thrush Duo). These were retained to capture broad prescribing where fluconazole is supplied as part of a dual-therapy pack.

Borderline cases

Combination products containing fluconazole and clotrimazole were considered borderline because they include both a systemic antifungal (fluconazole) and a topical antifungal (clotrimazole). These products were included in the final codelist to reflect routine community prescribing practice for thrush treatment, where combination packs are commonly issued as a single supply rather than separate prescriptions.

Sensitivity vs specificity

This codelist is sensitive, aiming to capture all prescribing exposure to fluconazole in routine care. This includes standalone fluconazole products as well as combination thrush treatment packs where fluconazole is present, in order to ensure complete capture of antifungal prescribing patterns relevant to Pharmacy First analyses (uti controls).

Additional information

Combination packs were retained due to their relevance in community management of vulvovaginal candidiasis and their frequent use in real-world prescribing pathways. Future refinements may consider separating pure fluconazole prescribing from combination antifungal therapy depending on the analytical objective.