From the Guidelines
For recurrent candidiasis symptoms, the recommended treatment for suppression is oral fluconazole 100-200 mg three times weekly. This regimen is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1. The study recommends chronic suppressive therapy with fluconazole for patients who have recurrent esophagitis, and this dosage has been shown to be effective in preventing recurrences while minimizing side effects.
Key Points:
- The dosage of fluconazole for suppression of recurrent candidiasis symptoms is 100-200 mg three times weekly.
- This regimen is recommended for patients who have recurrent esophagitis.
- Fluconazole works by inhibiting fungal cytochrome P450-dependent enzymes, disrupting the synthesis of ergosterol, an essential component of fungal cell membranes.
- Patients should be monitored for potential side effects, including liver enzyme abnormalities, and those with liver disease may require dose adjustment.
Evidence:
The recommendation is based on the 2016 clinical practice guideline for the management of candidiasis by the Infectious Diseases Society of America 1. This study provides high-quality evidence for the use of fluconazole in the suppression of recurrent candidiasis symptoms. Other studies, such as the 2009 and 2016 updates, also support the use of fluconazole for this indication 1. However, the 2016 study is the most recent and highest quality, and its recommendations are prioritized.
From the FDA Drug Label
Patients with AIDS and cryptococcal meningitis or recurrent oropharyngeal candidiasis usually require maintenance therapy to prevent relapse The recommended dosage of fluconazole tablets for suppression of relapse of cryptococcal meningitis in patients with AIDS is 200 mg once daily.
The recommended treatment for suppressing recurrent candidiasis symptoms using oral fluconazole is 200 mg once daily for patients with AIDS, but the label does not specify the exact dosage for other cases of recurrent candidiasis. However, based on the information provided for oropharyngeal candidiasis, a dosage of 100 mg once daily after a loading dose could be considered, but this is not explicitly stated for recurrent symptoms suppression. 2
From the Research
Oral Fluconazole for Candidiasis Suppression
The use of oral fluconazole for suppressing recurrent candidiasis symptoms has been studied in various clinical trials.
- The efficacy of fluconazole as a prophylaxis of recurrent oral candidiasis in patients with advanced stages of HIV-infection was studied in a randomized, open study 3.
- The study found that prophylaxis with fluconazole clearly reduced the occurrence of oral candidiasis, with a significant reduction in relapses compared to the untreated control group.
Dosage and Administration
- A daily dosage of 50 mg or 100 mg of fluconazole was found to be effective in reducing the frequency of relapses of oral candidiasis 3.
- Weekly treatment with fluconazole (150 mg) was also found to be effective in preventing symptomatic vulvovaginal candidiasis 4.
Comparison with Other Treatments
- A single oral dose of 150 mg fluconazole was found to be as effective as 7-day clotrimazole vaginal treatment for Candida vaginitis 5.
- Fluconazole was also found to be effective in treating vaginal candidiasis, with a clinical response rate of 97% and a mycologic eradication rate of 93% 6.