What is the recommended dosage of fluconazole (an antifungal medication) for treating a yeast infection?

Fluconazole Dosing for Yeast Infection

For uncomplicated vulvovaginal candidiasis, take a single 150 mg oral dose of fluconazole. 1, 2, 3

Uncomplicated Vulvovaginal Candidiasis

• A single 150 mg oral dose is the standard treatment and achieves clinical cure rates exceeding 80-90% 1, 2, 3
• This recommendation comes from the Infectious Diseases Society of America guidelines and is supported by the FDA-approved dosing 1, 3
• Clinical response is typically evident within 5-16 days, with 97% of patients cured or markedly improved 4
• No loading dose or multiple-day regimen is needed for straightforward cases 3

Complicated Vulvovaginal Candidiasis

For severe acute vulvovaginal candidiasis, use fluconazole 150 mg every 72 hours for 2-3 total doses. 1, 2, 5

• Complicated cases include severe symptoms, recurrent infections (≥4 episodes per year), non-albicans Candida species, or immunocompromised hosts 1
• The two-dose regimen achieves significantly higher clinical cure rates in severe vaginitis compared to single-dose therapy (P = 0.015) 5
• Alternative approach: 10-14 days of topical therapy or oral fluconazole can be used for complicated cases 1, 2

Recurrent Vulvovaginal Candidiasis

For recurrent infections, use 10-14 days of induction therapy followed by fluconazole 150 mg once weekly for 6 months. 1, 2

• This maintenance regimen prevents relapse in women with recurrent disease 1
• The weekly dosing continues after initial control of the acute episode 1, 2

Urinary Tract Candida Infections (Different from Vaginal)

If the yeast infection involves the urinary tract rather than vaginal:

• Symptomatic cystitis: Fluconazole 200 mg (3 mg/kg) daily for 2 weeks 1, 2
• Pyelonephritis: Fluconazole 200-400 mg (3-6 mg/kg) daily for 2 weeks 1, 2

Key Clinical Considerations

• Confirm diagnosis before treatment with wet mount preparation using saline and 10% KOH to demonstrate yeast or hyphae 1
• Vaginal pH should be <4.5 in vulvovaginal candidiasis 1
• If wet mount is negative but clinical suspicion remains high, obtain vaginal cultures for Candida 1
• Over 90% of vaginal isolates are Candida albicans; non-albicans species predict significantly reduced response regardless of therapy duration 1, 5
• Fluconazole is not recommended during pregnancy or lactation 6
• Side effects are minimal, primarily mild gastrointestinal complaints (diarrhea and nausea in 1.9% each) 7

Common Pitfalls to Avoid

• Do not use prolonged therapy for uncomplicated cases—single-dose is equally effective and improves compliance 1, 4
• Do not assume treatment failure at 3-5 days; clinical response may take up to 14 days 4
• Do not overlook the possibility of non-albicans species in treatment failures, which require culture confirmation 5
• Relapse rates of 23% occur even with successful initial treatment, so counsel patients about recurrence 4