What is the recommended treatment for vaginitis candida using fluconazole (FLUCONAZOLE)?

From the Guidelines

For vulvovaginal candidiasis, the recommended treatment with fluconazole is a single 150 mg oral dose, as supported by the most recent and highest quality study 1. This one-time dose is typically sufficient for uncomplicated infections. For severe or complicated cases, a second 150 mg dose may be recommended 72 hours after the first dose. In recurrent vulvovaginal candidiasis, an initial regimen of 150 mg every 72 hours for three doses (days 1,4, and 7) may be followed by maintenance therapy of 150 mg once weekly for 6 months. Fluconazole works by inhibiting fungal cytochrome P450 enzyme 14α-demethylase, which disrupts ergosterol synthesis in the fungal cell membrane, leading to increased cellular permeability and cell death. The medication is well-absorbed orally with or without food and distributes throughout the body, including to the vaginal tissues. Some key points to consider when treating vulvovaginal candidiasis with fluconazole include:

• The diagnosis 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.
• Patients should be advised that symptoms may not resolve immediately after taking the medication, and improvement typically occurs within 2-3 days.
• Sexual partners generally do not require treatment unless they are symptomatic.
• Patients with diabetes should maintain good glycemic control, as elevated blood sugar can promote yeast growth. The evidence from the studies 1 supports the use of fluconazole as a first-line treatment for vulvovaginal candidiasis, but the most recent and highest quality study 1 provides the strongest recommendation for a single 150 mg oral dose.

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 treatment for vaginitis candida using fluconazole is a single oral dose of 150 mg 2.

• The treatment is administered as a single dose, and no further dosage is required.
• This dosage is specifically recommended for the treatment of vaginal candidiasis.

From the Research

Treatment of Vaginitis Candida with Fluconazole

• The recommended treatment for vaginitis candida using fluconazole is a single oral dose of 150 mg, which has been shown to be as effective as 7-day intravaginal clotrimazole therapy 3.
• A single dose of 150 mg fluconazole has been found to achieve clinical cure or improvement in 94% of patients and mycologic eradication in 77% of patients 3.
• However, for patients with severe or recurrent vaginitis, a 2-dose fluconazole regimen may be more effective, with higher clinical cure rates and mycologic responses 4.
• Maintenance fluconazole therapy, with a dose of 150 mg weekly for six months, has been shown to be effective in preventing symptomatic vulvovaginal candidiasis and reducing the rate of recurrence 5.
• Fluconazole has been found to be safe and well-tolerated, with a low incidence of side effects, including mild gastrointestinal complaints 6, 7.

Dosage and Administration

• The recommended dose of fluconazole for vaginitis candida is 150 mg, taken orally as a single dose 3, 6.
• For patients with severe or recurrent vaginitis, a 2-dose regimen of 150 mg fluconazole, given 3 days apart, may be more effective 4.
• Maintenance therapy with 150 mg fluconazole weekly for six months has been shown to be effective in preventing recurrence 5.

Efficacy and Safety

• Fluconazole has been found to be effective in treating vaginitis candida, with clinical cure rates ranging from 80-94% 3, 6, 7.
• The drug has been shown to be safe and well-tolerated, with a low incidence of side effects 3, 6, 7.
• However, fluconazole is not recommended for use during pregnancy or lactation 7.