Fluconazole Dosing for Vaginal Yeast Infection
For uncomplicated vaginal yeast infection, give fluconazole 150 mg as a single oral dose. 1, 2
Uncomplicated Infection (90% of cases)
A single 150 mg oral dose of fluconazole achieves >90% clinical cure rates and is the recommended first-line treatment according to the Infectious Diseases Society of America. 3, 1
This single-dose regimen is FDA-approved and provides therapeutic concentrations in vaginal secretions that are sustained long enough to produce high clinical and mycological responses. 2, 4
Uncomplicated infection is defined as mild-to-moderate, sporadic, nonrecurrent disease in an otherwise healthy woman with Candida albicans. 3
Complicated Infection (10% of cases)
For severe acute vaginal candidiasis, give fluconazole 150 mg every 72 hours for 2-3 total doses (days 1,4, and optionally day 7). 3, 1, 5
Complicated infection includes: 3
- Severe symptoms (extensive vulvar erythema, edema, excoriation, fissures)
- Recurrent infection (≥4 episodes per year)
- Non-albicans Candida species (especially C. glabrata)
- Abnormal host (uncontrolled diabetes, immunosuppression, pregnancy)
Special Considerations for Non-albicans Species
For C. glabrata infection unresponsive to oral azoles, use topical intravaginal boric acid 600 mg daily for 14 days (must be compounded by pharmacist in gelatin capsules). 3, 1
C. glabrata frequently fails azole therapy, and multivariate analysis shows non-albicans species predict significantly reduced response regardless of treatment duration. 3, 5
Recurrent Vulvovaginal Candidiasis
For recurrent infection (≥4 episodes/year), use a two-phase approach: 3, 1
- Induction phase: Fluconazole 150 mg every 72 hours for 3 doses (or topical azole for 10-14 days)
- Maintenance phase: Fluconazole 150 mg once weekly for 6 months
- This regimen keeps 90.8% of women disease-free at 6 months, though 40-50% recurrence can be expected after stopping maintenance therapy. 3, 1
Diagnostic Confirmation Before Treatment
Confirm diagnosis with wet mount preparation using saline and 10% KOH to demonstrate yeast or pseudohyphae before prescribing. 3, 1
Vaginal pH should be ≤4.5 (normal); elevated pH suggests bacterial vaginosis or trichomoniasis instead. 3, 1
If wet mount is negative but clinical suspicion remains high, obtain vaginal culture for Candida species. 3
Safety and Tolerability
Fluconazole is well tolerated with primarily mild, transient gastrointestinal side effects. 4, 6
Do not use during pregnancy or lactation. 7
Treatment of sexual partners is not recommended unless the male partner has symptomatic balanitis (erythema and pruritus of the glans). 3, 8
Common Pitfalls
Do not treat asymptomatic colonization—10-20% of women harbor Candida in the vagina without infection. 3
Azole-resistant C. albicans is extremely rare but can develop after prolonged azole exposure; consider this if treatment fails repeatedly. 3, 1
HIV status does not change treatment approach—identical response rates are expected in HIV-positive and HIV-negative women. 3, 1