Fluconazole Dosing for Yeast Infections
For uncomplicated vaginal yeast infections, give a single oral dose of fluconazole 150 mg. 1, 2, 3
Uncomplicated Vulvovaginal Candidiasis
- A single 150 mg oral dose of fluconazole is the standard treatment, achieving >90% clinical response rates 1
- This single-dose regimen is as effective as multi-day topical therapies but provides faster symptom relief 4
- The FDA-approved dosing confirms 150 mg as a single oral dose for vaginal candidiasis 3
Complicated Vulvovaginal Candidiasis
For severe or complicated infections, use fluconazole 150 mg every 72 hours for 2-3 doses total. 1, 2, 5
Complicated VVC is defined as:
- Severe disease (extensive vulvar erythema, edema, excoriation, fissures) 1
- Recurrent disease (≥4 episodes per year) 1
- Non-albicans Candida species 1
- Immunocompromised host (diabetes, HIV, immunosuppressive therapy) 1
The evidence shows that women with severe vaginitis achieve significantly higher clinical cure rates with the 2-dose regimen compared to single-dose therapy (P=0.015 at day 14) 5. However, women with recurrent but not severe vaginitis did not benefit from the additional dose 5.
Recurrent Vulvovaginal Candidiasis
For recurrent infections (≥4 episodes/year), use induction therapy followed by long-term maintenance: 1, 2
- Induction phase: 10-14 days of topical azole OR oral fluconazole 1
- Maintenance phase: Fluconazole 150 mg once weekly for 6 months 1, 2
This suppressive regimen is necessary because recurrent VVC typically involves azole-susceptible C. albicans that requires prolonged therapy to prevent relapse 1.
Other Candida Infections (Non-Vaginal)
Urinary Tract Infections
- Cystitis: Fluconazole 200 mg (3 mg/kg) daily for 2 weeks 2
- Pyelonephritis: Fluconazole 200-400 mg (3-6 mg/kg) daily for 2 weeks 2
Oropharyngeal Candidiasis
- Loading dose: 200 mg on day 1, then 100 mg once daily for at least 2 weeks 3
- Moderate to severe disease: 100-200 mg daily for 7-14 days 1
Esophageal Candidiasis
- Standard dosing: 200 mg on day 1, then 100 mg once daily 3
- Severe cases: Up to 400 mg daily may be used 3
- Treat for minimum 3 weeks and at least 2 weeks after symptom resolution 3
Important Clinical Considerations
Common pitfalls to avoid:
- Non-albicans Candida (especially C. glabrata) predicts significantly reduced response to fluconazole regardless of treatment duration 5. Consider alternative agents like topical boric acid 600 mg daily for 14 days for C. glabrata 1
- C. krusei is intrinsically fluconazole-resistant and requires amphotericin B 1
- Confirm diagnosis with wet mount/KOH preparation before treating, as symptoms are nonspecific 1
- Fluconazole is not recommended during pregnancy or lactation 6
- The bioavailability exceeds 93% for oral formulations, making oral and IV dosing equivalent 3, 7