Fluconazole Dosing for Vaginal Candidiasis
For uncomplicated vaginal candidiasis, give a single oral dose of fluconazole 150 mg, which achieves clinical cure rates exceeding 90%. 1, 2
Standard Dosing by Clinical Presentation
Uncomplicated Acute Vaginal Candidiasis
- Single 150 mg oral dose is first-line therapy 1, 2
- This regimen provides clinical cure or improvement in 94-97% of patients at 14-day follow-up 3
- Mycological eradication occurs in 77-93% of cases 3, 4
- Long-term cure rates (35-62 days) remain high at 75-88% 3, 4
Severe Acute Vaginal Candidiasis
- Fluconazole 150 mg every 72 hours for 2-3 total doses 1
- This multi-dose regimen demonstrates superior clinical and mycological cure rates compared to single-dose therapy in severe presentations 1
Recurrent Vulvovaginal Candidiasis
- Initial induction phase: Topical agent or oral fluconazole for 10-14 days 1
- Maintenance phase: Fluconazole 150 mg weekly for 6 months 1
- This approach keeps 90.8% of women disease-free at 6 months 1
Important Clinical Considerations
Diagnostic Confirmation
- Confirm diagnosis with wet mount preparation using saline and 10% potassium hydroxide to demonstrate yeast or hyphae before treatment 1
- Normal vaginal pH (4.0-4.5) is typical with candida infections 1
- If wet mount is negative but clinical suspicion remains high, obtain vaginal cultures for Candida 1
Treatment Response by Patient History
- Patients with history of recurrent vaginitis have significantly lower response rates (both clinically and mycologically, p < 0.001) compared to those without recurrent disease 3
- These patients may require the extended maintenance regimen described above rather than single-dose therapy 1
Special Populations and Resistance
- Treatment approach should not differ based on HIV status 1
- Azole-resistant C. albicans is extremely rare but can develop following prolonged azole exposure 1
- For C. glabrata infections unresponsive to oral azoles, use intravaginal boric acid 600 mg daily for 14 days as first-line alternative 1