What is the recommended dosage of Diflucan (fluconazole) for treating a yeast infection?

Fluconazole Dosing for Vaginal Yeast Infection

For uncomplicated vaginal yeast infections, give a single oral dose of fluconazole 150 mg. 1, 2

Standard Treatment Approach

Uncomplicated Vulvovaginal Candidiasis (90% of cases)

• Single dose: Fluconazole 150 mg orally once is the recommended treatment according to the Infectious Diseases Society of America (IDSA) 2016 guidelines 1
• This achieves 97% clinical cure rates at 5-16 days and 88% cure rates at long-term follow-up (27-62 days) 3
• Topical antifungal agents are equally effective alternatives, though no single topical agent is superior to another 1
• The FDA label confirms 150 mg as a single oral dose for vaginal candidiasis 2

Severe Acute Vulvovaginal Candidiasis (Complicated Disease)

• Fluconazole 150 mg every 72 hours for 2-3 total doses is recommended for severe symptoms 1
• The multi-dose regimen achieves significantly higher clinical cure rates (P=0.015) compared to single-dose therapy in severe cases 4
• Severe disease is defined by extensive vulvar erythema, edema, excoriation, and fissure formation 1

Recurrent Vulvovaginal Candidiasis (≥4 episodes per year)

• Induction therapy: 10-14 days with topical agent OR oral fluconazole 1
• Maintenance therapy: Fluconazole 150 mg weekly for 6 months 1
• This maintenance regimen keeps 90.8% of women disease-free at 6 months and extends median time to recurrence to 10.2 months versus 4.0 months with placebo (P<0.001) 5
• After stopping maintenance therapy, 42.9% remain disease-free at 12 months 5

Species-Specific Considerations

Candida albicans (Most Common - 83-92% of cases)

• Standard single-dose fluconazole 150 mg is highly effective with 95.5% cure rates 6
• No resistance concerns with standard therapy 5

Candida glabrata (10-11% of cases)

• First-line: Topical intravaginal boric acid 600 mg daily for 14 days in gelatin capsule 1
• Alternative: Nystatin intravaginal suppositories 100,000 units daily for 14 days 1
• Third option: Topical 17% flucytosine cream ± 3% amphotericin B cream daily for 14 days 1
• Oral fluconazole is less effective for C. glabrata, with significantly reduced response rates regardless of therapy duration 4

Candida krusei

• Intrinsically fluconazole-resistant 1
• Requires alternative antifungal therapy (not fluconazole) 6

Common Pitfalls to Avoid

Inadequate treatment duration: Single-dose therapy is sufficient for uncomplicated cases; do not prescribe multi-day courses unless disease is severe or recurrent 1, 2

Treating asymptomatic colonization: Only treat symptomatic infections; asymptomatic vaginal Candida does not require therapy 1

Ignoring rectal reservoir: Persistent rectal Candida colonization is associated with vaginal treatment failure; patients with negative rectal cultures at follow-up maintain mycological cure in 96% of cases 7

Premature discontinuation of maintenance therapy: For recurrent disease, the full 6-month maintenance course is necessary to achieve sustained remission 5

Assuming all yeast infections are C. albicans: Non-albicans species (especially C. glabrata) require different treatment approaches and predict reduced response to fluconazole 4