Fluconazole Dosing for Vaginal Candidiasis
For uncomplicated vaginal candidiasis, administer a single oral dose of fluconazole 150 mg, which achieves clinical cure rates exceeding 90%. 1, 2, 3
Uncomplicated Vaginal Candidiasis
- Single-dose therapy with fluconazole 150 mg orally is the standard first-line treatment 1, 2, 3
- This represents approximately 90% of vaginal candidiasis cases 1
- Clinical cure rates range from 92-99% at short-term evaluation (5 days post-treatment) 4
- Topical azole agents for 1-7 days are equally effective alternatives if oral therapy is contraindicated 1
Complicated Vaginal Candidiasis (Severe Acute Disease)
For severe acute vulvovaginal candidiasis, administer fluconazole 150 mg every 72 hours for a total of 2-3 doses. 2, 5
- This multi-dose regimen achieves significantly higher clinical cure rates compared to single-dose therapy in severe disease (P=0.015 at day 14) 6
- Higher clinical and mycologic responses persist at day 35 with the 2-dose regimen 6
- Severe disease is defined by extensive vulvar erythema, edema, excoriation, and fissure formation 1
Recurrent Vulvovaginal Candidiasis
Initial induction therapy: Administer either topical azole for 10-14 days OR oral fluconazole (typically three 150-mg doses at 72-hour intervals). 1, 2, 7
Maintenance therapy: Fluconazole 150 mg orally once weekly for 6 months. 1, 2, 7
- This maintenance regimen keeps 90.8% of women disease-free at 6 months 7
- After stopping maintenance therapy, 42.9% remain disease-free at 12 months versus 21.9% with placebo 7
- Median time to clinical recurrence is 10.2 months with fluconazole versus 4.0 months with placebo (P<0.001) 7
- Recurrent disease is defined as 4 or more episodes per year 1
Non-Albicans Species (C. glabrata)
For C. glabrata vulvovaginitis unresponsive to azoles, use topical intravaginal boric acid 600 mg in gelatin capsules daily for 14 days. 2, 5
- Alternative options include nystatin intravaginal suppositories 100,000 units daily for 14 days 2
- Another alternative is topical 17% flucytosine cream (alone or combined with 3% amphotericin B cream) daily for 14 days 2
- Non-albicans Candida species predict significantly reduced clinical and mycologic response to fluconazole regardless of treatment duration 6
Critical Clinical Pitfalls to Avoid
- Confirm diagnosis before treatment: Obtain wet mount preparation with saline and 10% potassium hydroxide to demonstrate yeast or hyphae 5
- If wet mount is negative but clinical suspicion remains high, obtain vaginal cultures for Candida 5
- Do not use single-dose therapy for severe disease: Women with extensive vulvar involvement require the 2-3 dose regimen 2, 6
- Recognize that recurrent disease requires maintenance therapy: Simply treating acute episodes without suppressive therapy leads to rapid recurrence 7
- Azole-resistant C. albicans is extremely rare but can develop following prolonged azole exposure 5