What is the recommended dosage of Diflucan (fluconazole) for treating thrush?

Fluconazole Dosing for Oral Thrush (Oropharyngeal Candidiasis)

For moderate to severe oral thrush, oral fluconazole 100-200 mg daily for 7-14 days is the recommended treatment. 1

Treatment Recommendations Based on Severity

Mild Thrush

• First-line options include:
  • Clotrimazole troches, 10 mg 5 times daily for 7-14 days 1
  • Miconazole mucoadhesive buccal 50-mg tablet applied once daily for 7-14 days 1
• Alternative options include:
  • Nystatin suspension (100,000 U/mL) 4-6 mL 4 times daily for 7-14 days 1, 2
  • Nystatin pastilles (200,000 U each) 1-2 pastilles 4 times daily for 7-14 days 1

Moderate to Severe Thrush

• Oral fluconazole 100-200 mg daily for 7-14 days is strongly recommended 1
• Single-dose fluconazole 150 mg has shown 96.5% improvement in symptoms in palliative care patients with oral thrush 3

Special Populations

HIV-Infected Patients

• Fluconazole has demonstrated superior clinical cure rates compared to clotrimazole for thrush in HIV-infected patients 4
• For recurrent infections in HIV patients, chronic suppressive therapy with fluconazole 100 mg three times weekly is recommended 1
• Antiretroviral therapy is strongly recommended to reduce recurrent infections 1

Diabetic Patients

• Fluconazole 100-200 mg/day has shown approximately 90% success rate in treating oral candidiasis in diabetic patients 5
• Higher dosages (up to 800 mg/day) may be required in severe cases 5

Infants

• Fluconazole suspension 3 mg/kg once daily for 7 days has shown superior efficacy (100% cure rate) compared to nystatin suspension (32% cure rate) 2
• For pediatric patients, the recommended dosage is 6 mg/kg on the first day, followed by 3 mg/kg once daily for at least 2 weeks 6

Fluconazole-Refractory Disease

For patients who fail to respond to fluconazole therapy:

• Itraconazole solution, 200 mg once daily for up to 28 days 1
• Posaconazole suspension, 400 mg twice daily for 3 days then 400 mg daily for up to 28 days 1
• Voriconazole, 200 mg twice daily 1
• Amphotericin B deoxycholate oral suspension, 100 mg/mL 4 times daily 1

Additional Considerations

Denture-Related Candidiasis

• Disinfection of dentures in addition to antifungal therapy is strongly recommended 1
• Remove dentures at night and clean them thoroughly 1

Monitoring and Follow-up

• Treatment should continue for at least 2 weeks to decrease the likelihood of relapse 6
• Patients with persistent symptoms despite appropriate therapy should be evaluated for fluconazole resistance, especially those on long-term prophylaxis 7

Potential Pitfalls

• Fluconazole resistance may develop, particularly in patients with low CD4 counts who are taking fluconazole prophylactically for recurrent thrush 7
• Recurrence following treatment is common and usually due to the same strain of Candida 7
• Inadequate treatment duration is a common cause of recurrence; ensure full course completion 1

Remember that oral thrush may be a sign of underlying immunosuppression or systemic disease, particularly when it occurs in adults without obvious risk factors or when it is recurrent despite appropriate therapy.