What is the recommended dose of fluconazole (antifungal medication) for treating a yeast infection?

Fluconazole Dosing for Yeast Infections

For uncomplicated vulvovaginal candidiasis, a single 150 mg oral dose of fluconazole is the recommended treatment. 1, 2

Treatment Algorithm Based on Type of Yeast Infection

Vulvovaginal Candidiasis (VVC)

• Uncomplicated VVC:

  • First-line: Fluconazole 150 mg as a single oral dose 1, 2
  • Alternative: Topical antifungal agents (clotrimazole, miconazole, or nystatin) 1, 3

• Severe VVC:

  • Fluconazole 150 mg every 72 hours for a total of 2-3 doses 1, 4

• Recurrent VVC:

  • Initial induction: 10-14 days of topical therapy or oral fluconazole
  • Maintenance: Fluconazole 150 mg weekly for 6 months 1, 5

• C. glabrata VVC (fluconazole-resistant):

  • Topical intravaginal boric acid 600 mg daily for 14 days 1
  • Alternative: Nystatin intravaginal suppositories 100,000 units daily for 14 days 1

Urinary Tract Candidiasis

• Asymptomatic cystitis:

  • Generally no treatment required unless high-risk patient 1
  • For high-risk patients or those undergoing urologic procedures: Fluconazole 200-400 mg daily 1

• Symptomatic cystitis:

  • Fluconazole 200 mg daily for 2 weeks 1

• Pyelonephritis:

  • Fluconazole 200-400 mg daily for 2 weeks 1

Efficacy and Safety Considerations

Fluconazole has demonstrated excellent efficacy for vulvovaginal candidiasis with cure rates exceeding 80% in clinical trials 6, 7, 8. The single-dose regimen offers significant advantages including:

• Convenience and high patient acceptability
• Excellent bioavailability (>90%)
• Low incidence of side effects (primarily mild gastrointestinal complaints) 7

Important Clinical Pearls

• Diagnosis confirmation: Before initiating treatment, confirm diagnosis through wet mount preparation with saline and potassium hydroxide to demonstrate yeast or hyphae 1

• Treatment failure: Consider non-albicans Candida species if standard treatment fails, as these may require alternative therapies 4

• Pregnancy: Fluconazole is not recommended during pregnancy or lactation; topical agents are preferred 6

• Drug interactions: Be aware of potential interactions with medications metabolized through CYP3A4 pathway

• Follow-up: For uncomplicated cases, routine follow-up is not necessary if symptoms resolve. For recurrent or complicated cases, follow-up is recommended to confirm clinical and mycological cure

The single 150 mg oral dose of fluconazole represents the optimal balance of efficacy, safety, and convenience for most patients with uncomplicated vulvovaginal candidiasis, while more complex cases require tailored approaches as outlined above.