Fluconazole as a One-Dose Treatment
Yes, fluconazole is a one-dose treatment specifically for uncomplicated vulvovaginal candidiasis, where a single 150 mg oral dose is highly effective. 1
When Single-Dose Fluconazole is Appropriate
For uncomplicated vulvovaginal candidiasis (representing ~90% of cases), a single 150 mg oral dose of fluconazole achieves clinical cure rates of 92-99% at short-term evaluation and 88-91% at long-term follow-up. 1, 2, 3
Defining Uncomplicated Disease
Uncomplicated vulvovaginal candidiasis includes:
- Mild-to-moderate symptoms 1
- Sporadic, non-recurrent episodes 1
- Normal host (no diabetes, immunosuppression) 1
- Infection caused by Candida albicans (not non-albicans species) 1
When Single-Dose is NOT Sufficient
Severe Acute Vulvovaginal Candidiasis
For severe acute disease, fluconazole 150 mg should be given every 72 hours for a total of 2-3 doses (not a single dose). 1, 4
Recurrent Vulvovaginal Candidiasis
For recurrent infections, initial induction therapy with 10-14 days of oral fluconazole is required, followed by maintenance therapy with fluconazole 150 mg weekly for 6 months. 1, 4
Non-Albicans Species
For C. glabrata vulvovaginitis unresponsive to oral azoles, topical intravaginal boric acid 600 mg daily for 14 days is recommended (single-dose fluconazole is ineffective). 1
Other Candida Infections Requiring Multi-Dose Regimens
Fluconazole is NOT a one-dose treatment for:
- Symptomatic cystitis: 200 mg daily for 2 weeks 1
- Pyelonephritis: 200-400 mg daily for 2 weeks 1
- Oropharyngeal candidiasis: 200 mg loading dose, then 100 mg daily for at least 2 weeks 1
- Esophageal candidiasis: 200 mg loading dose, then 100 mg daily for minimum 3 weeks 1
- Candidemia/disseminated candidiasis: 400-800 mg daily for extended periods 1
- Osteomyelitis: 400 mg daily for 6-12 months 1
- CNS candidiasis: 400-800 mg daily until resolution 1
Clinical Considerations
The single 150 mg dose achieves therapeutic concentrations in vaginal secretions that are sustained for sufficient duration to produce high clinical and mycological responses. 2, 5
The convenience of single-dose therapy must be weighed against a higher incidence of drug-related adverse events with fluconazole (26%) versus intravaginal agents (16%) in U.S. comparative studies. 6
Common adverse effects from the single 150 mg dose include headache (13%), nausea (7%), and abdominal pain (6%), though most are mild to moderate. 6
Common Pitfalls
- Do not use single-dose fluconazole for complicated vulvovaginal candidiasis (severe, recurrent, non-albicans species, or abnormal host). 1
- Do not assume single-dose therapy is appropriate for any Candida infection other than uncomplicated vulvovaginal candidiasis. 1
- Confirm the diagnosis before treatment - approximately 10-20% of women harbor Candida species asymptomatically, and identifying Candida by culture without symptoms should not lead to treatment. 1
- Fluconazole is not recommended during pregnancy or lactation. 7