What is the standard dose of Diflucan (fluconazole) for an adult patient with a yeast infection?

Standard Dose of Diflucan (Fluconazole) for Adult Yeast Infections

For uncomplicated vulvovaginal candidiasis in adults, the standard dose is a single oral dose of fluconazole 150 mg. 1, 2

Dosing by Type of Yeast Infection

Vulvovaginal Candidiasis (Uncomplicated)

• Single dose of 150 mg orally is the standard treatment, with clinical cure rates exceeding 90% 3, 2, 4
• This single-dose regimen is as effective as 3-day topical therapy and relieves symptoms more rapidly 5
• For severe acute vulvovaginal candidiasis, use fluconazole 150 mg every 72 hours for a total of 2-3 doses 1

Recurrent Vulvovaginal Candidiasis

• For patients with ≥4 episodes per year, use 10-14 days of induction therapy (either topical or oral fluconazole), followed by fluconazole 150 mg weekly for 6 months as maintenance therapy 1, 3
• This maintenance regimen reduces recurrence rates from 64% to 9% at 6 months 3

Oropharyngeal Candidiasis

• Mild disease: Clotrimazole troches 10 mg five times daily for 7-14 days 3, 6
• Moderate-to-severe disease: Fluconazole 200 mg on day 1, then 100 mg once daily for 7-14 days (minimum 2 weeks) 3, 2

Esophageal Candidiasis

• Fluconazole 200 mg on day 1, then 100 mg once daily for minimum 3 weeks and at least 2 weeks after symptom resolution 2
• Doses up to 400 mg daily may be used based on response 2

Urinary Tract Candidiasis

• Asymptomatic candiduria in immunocompetent patients does NOT require treatment 3
• Symptomatic cystitis: Fluconazole 200 mg daily for 2 weeks 3
• Daily doses of 50-200 mg have been used for Candida UTIs and peritonitis 2

Systemic/Invasive Candidiasis

• Loading dose of 800 mg on day 1, followed by 400 mg daily 1, 2
• This loading dose strategy achieves steady-state concentrations by day 2 2
• Continue treatment until clinical parameters or laboratory tests indicate resolution of active infection 2

Critical Clinical Pitfalls to Avoid

Inappropriate Prophylaxis

• Do NOT use fluconazole prophylaxis routinely in immunocompetent patients taking antibiotics, even with history of recurrent yeast infections 3
• Prophylaxis in immunocompetent patients promotes resistance without proven benefit 3

Resistance Considerations

• Avoid fluconazole for empirical therapy in patients who have received azole prophylaxis; use an echinocandin instead 1, 6
• C. glabrata may develop fluconazole resistance during therapy, requiring switch to amphotericin B deoxycholate 0.3-0.6 mg/kg daily 3
• For fluconazole-resistant C. glabrata vulvovaginitis, use intravaginal boric acid 600 mg daily for 14 days 1

Catheter Management

• Remove indwelling bladder catheters when treating urinary candidiasis, as continuing catheters significantly reduces cure rates 3

Drug Interactions

• Avoid concomitant use of fluconazole and clopidogrel, as this reduces antiplatelet efficacy by 25-30% 6

Special Populations Requiring Different Dosing

High-Risk Patients Requiring Prophylaxis

• Neutropenic patients: 400 mg daily during chemotherapy-induced neutropenia 1, 3
• ICU patients: 800 mg loading dose, then 400 mg daily (only in units with high invasive candidiasis incidence) 1, 3
• Bone marrow transplant recipients: 400 mg daily starting before anticipated neutropenia, continuing for 7 days after neutrophil count >1000 cells/mm³ 3, 2
• Solid organ transplant recipients: 200-400 mg daily for high-risk liver, pancreas, and small bowel transplant recipients 1, 3

AIDS Patients

• Cryptococcal meningitis treatment: 400 mg on day 1, then 200 mg once daily (or 400 mg daily based on response) for 10-12 weeks after CSF becomes culture-negative 2
• Maintenance therapy for cryptococcal meningitis: 200 mg once daily 2
• AIDS patients typically require maintenance therapy to prevent relapse of oropharyngeal candidiasis 2