What is the recommended regimen of Diflucan (fluconazole) for treating candidiasis on the tongue?

Recommended Fluconazole Regimen for Oral Candidiasis

For oropharyngeal candidiasis (oral thrush), fluconazole should be administered at 200 mg on the first day, followed by 100 mg once daily for at least 14 days and continued for at least 2 weeks after symptom resolution. 1, 2

Dosing Regimen Details

• Initial dose: 200 mg fluconazole on day 1
• Maintenance dose: 100 mg once daily
• Duration: Minimum 14 days, and should continue for at least 48 hours after symptoms resolve 1
• Administration: Oral tablet with or without food

The recommended regimen is based on the FDA-approved dosing guidelines and clinical practice recommendations from the Infectious Diseases Society of America 1, 2. This dosing strategy ensures adequate drug levels from the beginning of treatment while maintaining therapeutic concentrations throughout the course.

Clinical Considerations

Treatment Response

• Clinical improvement typically occurs within several days of starting treatment
• Complete the full course even if symptoms improve quickly to prevent relapse
• If no improvement is seen after 7-10 days, consider:
  • Resistance to fluconazole
  • Need for higher dosing (up to 400 mg/day may be used in severe cases) 2
  • Alternative antifungal agents

Special Populations

• Children: 6 mg/kg on first day, followed by 3 mg/kg once daily 2
• Immunocompromised patients: May require longer treatment duration and closer follow-up 1
• HIV/AIDS patients: Consider maintenance therapy with fluconazole 100 mg three times weekly for prevention of recurrence 1

Alternative Options for Refractory Cases

If fluconazole fails to resolve the infection, consider:

1. Itraconazole solution: 200 mg daily for up to 28 days (effective in 64-80% of fluconazole-refractory cases) 1
2. Posaconazole suspension: 400 mg twice daily for 3 days, then 400 mg daily for up to 28 days (effective in approximately 75% of refractory cases) 1
3. Voriconazole: 200 mg twice daily (note: higher rate of adverse events) 1

Adjunctive Measures

For optimal outcomes, recommend these additional measures:

• Maintain good oral hygiene
• Remove and clean dentures thoroughly daily (if applicable)
• Avoid potential irritants (smoking, alcohol, spicy foods)
• Stay adequately hydrated
• Use a soft toothbrush for oral care

Follow-up and Monitoring

• Schedule follow-up within 7-10 days to assess treatment response
• Monitor for hepatotoxicity if treatment extends beyond 7-10 days 1
• Investigate underlying causes (immunosuppression, diabetes) for recurrent infections 1

Important Considerations

• Single-dose fluconazole (750 mg) has shown similar efficacy to standard 14-day therapy in HIV patients 3, but the standard 14-day regimen remains the recommended approach for most patients
• Fluconazole has excellent oral bioavailability, making oral administration as effective as intravenous dosing 2, 4
• Drug interactions may occur with cyclosporin, phenytoin, oral hypoglycemics, and warfarin 4