What is the recommended dose of Diflucan (fluconazole) for an adult female patient with an uncomplicated yeast infection and no severe underlying medical conditions?

Diflucan Dosing for Uncomplicated Yeast Infection

For an uncomplicated vaginal yeast infection in an adult female, administer a single oral dose of fluconazole 150 mg. 1, 2

Uncomplicated vs. Complicated Disease Classification

Uncomplicated vulvovaginal candidiasis (approximately 90% of cases) is characterized by mild-to-moderate symptoms, infrequent episodes (<4 per year), infection with Candida albicans, and occurs in immunocompetent women. 1

Complicated vulvovaginal candidiasis (approximately 10% of cases) includes severe symptoms, recurrent disease (≥4 episodes per year), infection with non-albicans species (C. glabrata, C. krusei), or infection in immunocompromised hosts (diabetes, HIV, immunosuppressive therapy). 1

Standard Treatment Regimen

For Uncomplicated Disease:

• Single-dose fluconazole 150 mg orally achieves >90% clinical response rates. 1, 3, 2
• This regimen is equivalent in efficacy to topical antifungal agents but offers superior convenience and more rapid symptom relief. 1, 4
• Clinical cure or improvement should be evident within 5-16 days. 3

For Severe Acute (Complicated) Disease:

• Fluconazole 150 mg every 72 hours for a total of 2-3 doses (total 300-450 mg over 4-6 days). 1, 3
• This extended regimen achieves significantly higher clinical cure rates in severe vaginitis compared to single-dose therapy (P=0.015 at day 14). 5

For Recurrent Vulvovaginal Candidiasis:

• Induction therapy: Fluconazole 150 mg every 72 hours for 3 doses OR topical azole for 10-14 days. 1, 3
• Maintenance therapy: Fluconazole 150 mg weekly for 6 months. 1, 3
• This maintenance regimen achieves 90.8% disease-free status at 6 months versus 35.9% with placebo (P<0.001). 6
• After cessation of maintenance therapy, expect 40-50% recurrence rate. 1, 6

Species-Specific Considerations

Candida albicans (92% of cases):

• Responds excellently to standard fluconazole dosing as outlined above. 1, 5

Candida glabrata:

• Frequently resistant to azole therapy, including fluconazole. 1
• First-line alternative: Intravaginal boric acid 600 mg daily for 14 days (compounded in gelatin capsules). 1
• Second-line alternative: Nystatin intravaginal suppositories 100,000 units daily for 14 days. 1
• Third-line alternative: Topical 17% flucytosine cream alone or combined with 3% amphotericin B cream daily for 14 days (requires compounding). 1

Candida krusei:

• Intrinsically resistant to fluconazole. 1
• Responds to all topical antifungal agents. 1

Critical Pitfalls to Avoid

Do not treat asymptomatic colonization. 10-20% of women harbor Candida species without symptoms, and treatment is not indicated in these cases. 3

Confirm the diagnosis before treating. Symptoms of pruritus, vaginal discharge, dysuria, and dyspareunia are nonspecific and can result from bacterial vaginosis, trichomoniasis, or noninfectious causes. 1, 3

Diagnostic confirmation requires:

• Wet mount preparation with 10% potassium hydroxide to visualize yeast or pseudohyphae. 3
• Vaginal pH measurement (should be ≤4.5 for candidiasis; pH >4.5 suggests bacterial vaginosis or trichomoniasis). 3
• Vaginal culture if wet mount is negative but symptoms persist. 3

Recognize treatment failure patterns. If symptoms persist after treatment or recur within 2 months, re-evaluate with repeat cultures to identify non-albicans species requiring alternative therapy. 3

Avoid fluconazole during pregnancy and lactation. Use topical azole therapy for 7 days instead. 7

Expected Outcomes

Short-term assessment (5-16 days): 97-99% clinical cure or marked improvement with single-dose fluconazole. 8, 4

Long-term assessment (27-62 days): 88-93% sustained clinical cure with mycologic eradication in 72-73% of patients. 8, 4

Relapse/reinfection rate: Approximately 23% at long-term follow-up in patients who initially responded. 8

Safety Profile

Fluconazole is well-tolerated with minimal side effects, primarily mild gastrointestinal complaints (nausea, abdominal discomfort). 2, 8

Abnormal laboratory values occur in approximately 9% of patients but are minor and clinically insignificant. 8

Treatment discontinuation due to adverse effects is rare (<1%). 6