What is the recommended dosing of fluconazole (Fluconazole) for vulvovaginal candidiasis (VVC)?

Fluconazole Dosing for Vulvovaginal Candidiasis

For uncomplicated vulvovaginal candidiasis, a single 150 mg oral dose of fluconazole is the recommended standard treatment, with clinical efficacy rates of over 90%. 1, 2

Treatment Recommendations by Type of Infection

Uncomplicated Vulvovaginal Candidiasis

• Single 150 mg oral dose of fluconazole achieves high clinical and mycological response rates (>90%) 1, 2
• Therapeutic concentrations in vaginal secretions are rapidly achieved and sustained for sufficient duration 3
• Alternative: Short-course topical antifungal agents can be used with equivalent efficacy 4, 1

Complicated Vulvovaginal Candidiasis

Severe Acute Infection

• Fluconazole 150 mg every 72 hours for a total of 2-3 doses 1
• Treatment should continue until clinical parameters indicate the infection has subsided 2

Recurrent Vulvovaginal Candidiasis

• Initial induction therapy: 10-14 days of either topical antifungal or oral fluconazole 4, 1
• Followed by maintenance therapy: Fluconazole 150 mg weekly for 6 months 4, 1
• This regimen significantly reduces recurrence rates, with 90.8% of women remaining disease-free at 6 months compared to 35.9% with placebo 5

Species-Specific Treatment (Non-albicans Candida)

C. glabrata Infection (Fluconazole-Resistant)

• First-line: Topical intravaginal boric acid in gelatin capsules, 600 mg daily for 14 days 1
• Alternative: Nystatin intravaginal suppositories, 100,000 units daily for 14 days 4, 1
• Third option: Topical 17% flucytosine cream alone or combined with 3% AmB cream daily for 14 days 4, 1

Clinical Considerations and Potential Pitfalls

• Confirm diagnosis before initiating treatment with wet-mount preparation and pH testing (normal vaginal pH: 4.0-4.5) 4, 1
• Distinguish between uncomplicated (90% of cases) and complicated (10% of cases) vulvovaginal candidiasis, as treatment duration differs 4, 1
• For C. albicans infections, fluconazole resistance is extremely rare but can emerge following prolonged azole exposure 4
• Fluconazole is well-tolerated with minimal side effects, most commonly mild gastrointestinal symptoms 3, 6
• Single-dose oral therapy offers superior patient compliance compared to multi-day topical treatments 3, 7
• Fluconazole is not recommended during pregnancy or lactation 8

Treatment Algorithm

1. Diagnose with wet mount and pH testing 4
2. Determine if uncomplicated or complicated:
   • Uncomplicated: First episode or infrequent, mild to moderate symptoms, likely C. albicans, normal host 4
   • Complicated: Severe symptoms, non-albicans species, recurrent (≥4 episodes/year), or abnormal host 4
3. For uncomplicated: Single 150 mg oral fluconazole 1, 2
4. For complicated:
   • Severe: Fluconazole 150 mg every 72 hours for 2-3 doses 1
   • Recurrent: Induction (10-14 days) then maintenance (weekly for 6 months) 4, 5
   • C. glabrata: Use alternative treatments as fluconazole is often ineffective 4, 1