What is the recommended dose of Diflucan (fluconazole) for treating vaginal candida?

Fluconazole Dosing for Vaginal Candidiasis

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

Treatment Algorithm Based on Clinical Presentation

Uncomplicated Vaginal Candidiasis (90% of cases)

• Single oral dose of fluconazole 150 mg 1, 2, 3
• Alternatively, topical antifungal agents can be used with similar efficacy 1
• Clinical cure rates of >90% can be expected with either approach 3, 4

Severe Acute Vaginal Candidiasis

• Fluconazole 150 mg given every 72 hours for a total of 2-3 doses 1, 5
• This regimen has shown superior clinical and mycological cure rates compared to single-dose therapy in patients with severe symptoms 5

Complicated Cases - Non-albicans Species

For C. glabrata infection that is unresponsive to oral azoles:

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

Recurrent Vulvovaginal Candidiasis

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

Important Clinical Considerations

• Diagnosis should be confirmed by wet mount preparation with saline and 10% potassium hydroxide to demonstrate yeast or hyphae before starting treatment 1
• Normal vaginal pH (4.0-4.5) is typically present with candida infections 1
• For negative wet mount findings, vaginal cultures for Candida should be obtained 1
• Treatment of vulvovaginal candidiasis should not differ based on HIV status 1

Common Pitfalls and Caveats

• Women with a history of recurrent vaginitis are significantly less likely to respond to single-dose therapy compared to those without such history 3
• Non-albicans Candida species (especially C. glabrata) predict significantly reduced clinical and mycologic response regardless of therapy duration 5
• Azole-resistant C. albicans infections are extremely rare but can develop following prolonged azole exposure 1
• The most common side effects of oral fluconazole are mild gastrointestinal complaints 4
• Despite effective maintenance therapy, long-term cure of recurrent vulvovaginal candidiasis remains challenging, with recurrence rates increasing after discontinuation of maintenance therapy 6