What is the recommended dosage of fluconazole (antifungal medication) for a 72-hour outpatient treatment of vulvovaginal candidiasis?

From the Guidelines

For the treatment of vulvovaginal candidiasis in an outpatient setting over 72 hours, the recommended dosage of fluconazole is a single 150 mg oral tablet taken once, as supported by the Infectious Diseases Society of America's 2016 clinical practice guideline 1. This one-time dose is typically sufficient to treat uncomplicated vulvovaginal candidiasis. The medication works by inhibiting the synthesis of ergosterol, an essential component of fungal cell membranes, thereby disrupting membrane function and inhibiting fungal growth. Patients should be advised that symptom relief may not be immediate and can take up to 3 days to fully resolve. It's essential to note that fluconazole can be taken with or without food, and no alcohol restriction is necessary. If symptoms persist beyond 7 days after taking the medication, a follow-up with a healthcare provider is recommended as this may indicate either a resistant infection or an incorrect diagnosis, as outlined in the evidence summary 1. Pregnant women should avoid fluconazole due to potential risks to the fetus, and those with liver disease or taking certain medications should consult their doctor before use due to possible drug interactions. Key points to consider include:

• The diagnosis of vulvovaginal candidiasis should be confirmed by a wet-mount preparation with use of saline and 10% potassium hydroxide to demonstrate the presence of yeast or hyphae and a normal pH (4.0–4.5) 1.
• Uncomplicated infection can be effectively treated with either single-dose fluconazole or short-course fluconazole for 3 days, both of which achieve >90% response 1.
• Treatment of vulvovaginal candidiasis should not differ on the basis of human immunodeficiency virus (HIV) infection status; identical response rates are anticipated for HIV-positive and HIV-negative women 1.

From the FDA Drug Label

Dosage and Administration in Adults: Single Dose Vaginal candidiasis: The recommended dosage of fluconazole tablets for vaginal candidiasis is 150 mg as a single oral dose. The recommended dosage of fluconazole for a 72-hour outpatient treatment of vulvovaginal candidiasis is 150 mg as a single oral dose.

• This is a single dose treatment, so no additional doses are needed for 72 hours. 2

From the Research

Dosage of Fluconazole for 72-hour Outpatient Treatment

The recommended dosage of fluconazole for a 72-hour outpatient treatment of vulvovaginal candidiasis is as follows:

• A single oral dose of 150 mg of fluconazole is effective in treating vaginal candidiasis, with a clinical cure rate of 88% at long-term assessment 3.
• This dosage is also supported by another study, which found that a single oral dose of 150 mg of fluconazole was more effective in the long term and relieved symptoms more rapidly compared to intravaginal clotrimazole 4.
• However, for severe or recurrent candidiasis, a 2-dose fluconazole regimen (2 sequential 150-mg doses given 3 days apart) may be more effective in achieving clinical cure and mycologic eradication 5.

Considerations for Treatment

When considering treatment with fluconazole, the following points should be taken into account:

• The clinical response to treatment may vary depending on the severity and recurrence of the infection.
• Fluconazole is generally well tolerated, with few and minor side effects reported in clinical trials 3, 4.
• The treatment of Candida vaginitis may require individualization, and women with severe Candida vaginitis may benefit from a 2-dose fluconazole regimen 5.