Fluconazole Dosage for Vaginal Candidiasis
For uncomplicated vaginal candidiasis, administer a single 150 mg oral dose of fluconazole, which achieves clinical cure rates exceeding 90%. 1, 2, 3
Uncomplicated Vaginal Candidiasis
- Single-dose therapy with fluconazole 150 mg orally is the standard first-line treatment, as confirmed by both FDA labeling and IDSA guidelines 3, 4
- This regimen produces clinical cure rates of 92-99% at short-term evaluation (5 days post-treatment) and maintains 91% efficacy at 80-100 days 5, 6
- Topical azole agents (clotrimazole, miconazole, terconazole) for 1-7 days are equally effective alternatives, though oral therapy offers superior patient acceptability 4, 1
Complicated Vaginal Candidiasis
For severe acute vulvovaginal candidiasis, give fluconazole 150 mg every 72 hours for a total of 2-3 doses. 1, 2
- This multi-dose regimen achieves significantly higher clinical cure rates compared to single-dose therapy in severe cases (P=0.015 at day 14) 7
- Complicated cases include: severe symptoms, recurrent infections (≥4 episodes/year), non-albicans species, immunocompromised hosts, or uncontrolled diabetes 4
Recurrent Vulvovaginal Candidiasis
Initial induction therapy: Use topical azole or oral fluconazole for 10-14 days 1, 2
Maintenance therapy: Fluconazole 150 mg orally once weekly for 6 months 4, 1
- This maintenance regimen keeps 90.8% of women disease-free at 6 months 2
- Alternative maintenance options include ketoconazole 100 mg daily or itraconazole 100 mg every other day 4
Non-Albicans Species (Fluconazole-Resistant)
For C. glabrata infections unresponsive to azoles, use topical intravaginal boric acid 600 mg in gelatin capsules daily for 14 days. 4, 1, 2
- Alternative options include nystatin intravaginal suppositories 100,000 units daily for 14 days 1
- Topical 17% flucytosine cream alone or combined with 3% amphotericin B cream daily for 14 days is another option 1
- Azole therapy is unreliable for non-albicans species, and multivariate analysis confirms non-albicans infections predict significantly reduced response regardless of therapy duration 4, 7
Critical Clinical Pitfalls to Avoid
- Confirm diagnosis before treatment: Self-diagnosis of yeast vaginitis is unreliable and leads to overuse of antifungals with risk of contact dermatitis 4
- Diagnosis requires wet mount with saline and 10% KOH demonstrating yeast or hyphae; vaginal pH should be 4.0-4.5 2
- Do not use single-dose therapy for complicated cases: Women with severe symptoms require the 2-3 dose regimen for adequate response 7, 1
- Distinguish uncomplicated from complicated disease: This determines whether 1-day versus 7+ day therapy is needed 1
- Azole-resistant C. albicans is extremely rare but can develop after prolonged azole exposure 2