What is the recommended dosing of fluconazole (Fluconazole) for the treatment of thrush?

From the Guidelines

For the treatment of thrush, fluconazole is recommended at a dosage of 100–200 mg (3 mg/kg) daily for 7–14 days. This recommendation is based on the clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America 1. The guidelines suggest that for moderate to severe disease, oral fluconazole at the specified dosage is recommended (A-I).

• Key points to consider when prescribing fluconazole for thrush include:
  • The dosage of 100–200 mg daily is suitable for most patients with moderate to severe disease
  • Treatment duration is typically 7–14 days, but may need to be extended in severe cases or in immunocompromised patients
  • Fluconazole can be taken orally with or without food
  • Patients should be advised to complete the full course of treatment even if symptoms improve before completion to prevent recurrence
  • Potential side effects and interactions with other medications, such as warfarin, oral hypoglycemics, and some statins, should be discussed with patients
• It is also important to note that for mild disease, other treatment options such as clotrimazole troches or nystatin suspension may be recommended 1. However, for moderate to severe disease, fluconazole is a preferred treatment option due to its efficacy and convenience.

From the FDA Drug Label

Oropharyngeal candidiasis: The recommended dosage of fluconazole tablets for oropharyngeal candidiasis is 200 mg on the first day, followed by 100 mg once daily. Clinical evidence of oropharyngeal candidiasis generally resolves within several days, but treatment should be continued for at least 2 weeks to decrease the likelihood of relapse The recommended dosing of fluconazole for the treatment of thrush (oropharyngeal candidiasis) is:

• 200 mg on the first day,
• followed by 100 mg once daily. Treatment should be continued for at least 2 weeks to decrease the likelihood of relapse 2

From the Research

Fluconazole Dosing for Thrush

• The recommended dosing of fluconazole for the treatment of thrush is not explicitly stated in the provided studies, but it can be inferred from the context of the studies.
• According to the study 3, oral fluconazole is effective in treating oral candidiasis that does not respond to topical treatment, but the dosing regimen is not specified.
• The study 4 discusses the various presentations of oral candidiasis and the diagnostic methods and treatment alternatives, including pharmacologic management, but does not provide specific dosing information for fluconazole.
• The study 5 compares the safety and efficacy of fluconazole 150mg single dose and itraconazole 200mg per day for 3 days in the treatment of acute vaginal candidiasis, suggesting that a single dose of 150mg may be effective for some forms of candidiasis.

Antifungal Susceptibility and Resistance

• The studies 6 and 7 discuss the antifungal susceptibility and resistance patterns of Candida species, including fluconazole, but do not provide specific dosing recommendations for thrush.
• The study 6 found that 76% of Candida albicans isolates were resistant to fluconazole, while the study 7 found that only 0.3% of C. albicans isolates were resistant to fluconazole.

Treatment Alternatives

• The study 3 mentions that nystatin and miconazole are the most commonly used topical antifungal drugs, and that oral fluconazole is effective in treating oral candidiasis that does not respond to topical treatment.
• The study 4 discusses the various treatment alternatives for oral candidiasis, including polyenes, azoles, and echinocandins, but does not provide specific dosing information for fluconazole.