Fluconazole Dosing and Treatment Duration for Fungal Infections

Vulvovaginal Candidiasis

For uncomplicated vulvovaginal candidiasis, a single 150 mg oral dose of fluconazole is the recommended treatment. 1, 2

This single-dose regimen achieves cure rates exceeding 90% and is equivalent to topical azole therapy 1, 3
For severe or complicated cases, use fluconazole 150 mg every 72 hours for 2-3 doses (total of 2-3 doses) 2
Recurrent vulvovaginal candidiasis (≥4 episodes per year) requires a two-phase approach 1:
- Induction phase: 10-14 days of topical azole OR oral fluconazole 1
- Maintenance phase: Fluconazole 150 mg once weekly for 6 months 1, 2, 4
- This maintenance regimen achieves disease control in >90% of patients, though 40-50% may experience recurrence after stopping therapy 1, 4

No treatment is recommended except for high-risk patients undergoing urologic procedures 2
For high-risk patients: Fluconazole 200-400 mg daily for several days before and after the procedure 1, 2

Fluconazole 200 mg (3 mg/kg) daily for 2 weeks 1, 2
For fluconazole-resistant C. glabrata: Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days with or without flucytosine 25 mg/kg four times daily 1
For C. krusei: Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days 1

Fluconazole 200-400 mg (3-6 mg/kg) daily for 2 weeks 1, 2
Alternative for resistant organisms: Amphotericin B deoxycholate 0.5-0.7 mg/kg daily with or without flucytosine 25 mg/kg four times daily for 2 weeks 1
Critical caveat: If disseminated candidiasis is suspected, treat as candidemia rather than isolated pyelonephritis 1

Mild disease: Clotrimazole troches 10 mg five times daily for 7-14 days 1
Moderate to severe disease: Fluconazole 100-200 mg daily for 7-14 days 1
Fluconazole-refractory disease: Itraconazole solution 200 mg once daily OR posaconazole suspension 400 mg twice daily for 3 days, then 400 mg daily for up to 28 days 1
Chronic suppressive therapy (if needed for recurrent infection): Fluconazole 100 mg three times weekly 1

Fluconazole 200-400 mg (3-6 mg/kg) daily for 14-21 days 1
For patients unable to tolerate oral therapy: IV fluconazole 400 mg (6 mg/kg) daily OR an echinocandin 1
De-escalate to oral fluconazole once the patient can tolerate oral intake 1

Surgical removal is strongly recommended 1
Systemic antifungal therapy: Fluconazole 200-400 mg (3-6 mg/kg) daily OR amphotericin B deoxycholate 0.5-0.7 mg/kg daily with or without flucytosine 1
Local irrigation with amphotericin B deoxycholate (25-50 mg in 200-500 mL sterile water) through nephrostomy tubes is recommended as an adjunct 1

Fluconazole is the agent of choice, though specific dosing is based on limited anecdotal data 1
Most patients require surgical drainage in addition to antifungal therapy 1

C. glabrata shows reduced susceptibility to fluconazole; higher doses may be required (efficacy only 50% at standard doses) 5
C. krusei is intrinsically resistant to fluconazole and should NOT be treated with this agent 1, 5
C. parapsilosis and C. tropicalis respond well to fluconazole (efficacy 93% and 82%, respectively) 5

Do not treat asymptomatic candiduria unless the patient is high-risk or undergoing urologic procedures 1, 2
Remove or replace urinary catheters, nephrostomy tubes, or stents when feasible, as these devices perpetuate infection 1
For recurrent vulvovaginal candidiasis, do not skip the maintenance phase—the 6-month weekly regimen is essential for sustained disease control 1, 4
In HIV-infected patients with oropharyngeal candidiasis, antiretroviral therapy is critical to reduce recurrence rates 1

Fluconazole is generally well-tolerated with low incidence of side effects 3
Most common adverse effects are mild gastrointestinal complaints 3
Not recommended during pregnancy or lactation 6
Monitor for hepatotoxicity and exfoliative skin reactions, though these are rare 7