What is the recommended dosage of fluconazole (antifungal medication) for treating yeast infections?

Fluconazole Dosage for Yeast Infections

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

Dosing Recommendations by Type of Yeast Infection

Uncomplicated Vulvovaginal Candidiasis

• Single 150 mg oral dose of fluconazole 1, 2, 3
• Clinical cure rates with single-dose therapy exceed 90% for uncomplicated cases 3
• Alternative: topical antifungal agents (no single agent is superior to others) 1

Severe Acute Vulvovaginal Candidiasis

• Fluconazole 150 mg every 72 hours for a total of 2-3 doses 1, 4
• Two-dose regimen achieves significantly higher clinical cure rates in women with severe vaginitis compared to single-dose therapy 4

Recurrent Vulvovaginal Candidiasis

• Initial induction therapy with 10-14 days of a topical agent or oral fluconazole 1
• Followed by maintenance therapy with fluconazole 150 mg weekly for 6 months 1, 5
• This regimen keeps 90.8% of women disease-free at 6 months compared to only 35.9% with placebo 5

Non-albicans Candida Species Infections (e.g., C. glabrata)

• For infections unresponsive to oral azoles: 1
  • Topical intravaginal boric acid 600 mg daily for 14 days 1
  • Alternative: nystatin intravaginal suppositories 100,000 units daily for 14 days 1
  • Another option: topical 17% flucytosine cream alone or with 3% AmB cream daily for 14 days 1

Special Considerations

Urinary Tract Candidiasis

• Symptomatic cystitis: Fluconazole 200 mg (3 mg/kg) daily for 2 weeks 1
• Pyelonephritis: Fluconazole 200-400 mg (3-6 mg/kg) daily for 2 weeks 1
• For high-risk patients undergoing urologic procedures: Fluconazole 200-400 mg daily for several days before and after the procedure 1

Common Pitfalls to Avoid

• Failure to distinguish between uncomplicated and complicated vulvovaginal candidiasis can lead to inadequate treatment 1
• Non-albicans Candida species (particularly C. glabrata) have reduced response to fluconazole therapy and may require alternative treatments 4
• Recurrent infections require longer maintenance therapy to prevent relapse; short-term treatment is insufficient 5
• Inadequate duration of treatment may lead to recurrence of active infection 2

Clinical Decision Algorithm

1. Confirm diagnosis with clinical examination and wet mount/KOH preparation
2. Determine if infection is uncomplicated or complicated:
   • Uncomplicated: mild to moderate symptoms, infrequent episodes, likely C. albicans
   • Complicated: severe symptoms, recurrent episodes, non-albicans species, or abnormal host
3. For uncomplicated infection: single 150 mg dose of fluconazole 1, 2
4. For severe infection: fluconazole 150 mg every 72 hours for 2-3 doses 1
5. For recurrent infection: induction therapy followed by weekly fluconazole 150 mg for 6 months 1, 5
6. For suspected non-albicans infection or fluconazole failure: consider topical alternatives 1

The evidence strongly supports fluconazole as an effective, well-tolerated treatment for vulvovaginal candidiasis, with dosing regimens tailored to the specific clinical presentation 1, 2, 3.