What is the recommended dose of Diflucan (fluconazole) for a patient diagnosed with tinea, not a yeast infection?

Fluconazole Dosing for Tinea Infections

For tinea corporis and tinea cruris, fluconazole 150 mg once weekly for 2-4 weeks is the recommended oral regimen, while tinea pedis typically requires 150 mg once weekly for 4 weeks. 1, 2

Tinea Corporis and Tinea Cruris (Body and Groin)

• Fluconazole 150 mg once weekly for 2-4 weeks is highly effective, achieving 95% clinical and mycological cure rates in clinical trials 1
• Most patients (70%) require only 2 weekly doses, with 20% needing 3 doses and 10% requiring the full 4 doses 2
• This once-weekly regimen is possible because fluconazole achieves high concentrations in the stratum corneum with a long elimination half-life 1
• Alternative daily dosing of 50-100 mg fluconazole for 2-3 weeks is also effective 3

Tinea Pedis (Foot)

• Fluconazole 150 mg once weekly requires longer treatment duration, with 60% of patients needing 4 weekly doses 2
• Clinical cure rates are 70% with mycological eradication in 75% of cases at long-term follow-up 2
• The pulse dosing regimen of 150 mg once weekly has been validated as effective for tinea pedis 3

Tinea Capitis (Scalp) - Pediatric Consideration

• For children with tinea capitis, fluconazole 6-8 mg/kg once weekly for 8-12 weeks is effective for Trichophyton species 4, 5
• An alternative shorter regimen is 6 mg/kg daily for 2-3 weeks, achieving 88% cure rates 5
• Microsporum canis infections may require up to 16 weeks of once-weekly dosing 4

Critical Clinical Caveats

• These tinea dosing regimens are fundamentally different from Candida (yeast) infections, which require higher daily doses (200-400 mg daily) and longer treatment courses 6
• The once-weekly 150 mg regimen exploits fluconazole's unique pharmacokinetics in skin tissue but would be inadequate for systemic or mucosal Candida infections 1
• Treatment is well-tolerated with minimal adverse effects (primarily mild gastrointestinal complaints in <5% of patients) 1, 2, 4
• Topical azole therapy (clotrimazole 1% cream twice daily for 2-4 weeks) remains first-line for localized tinea infections, with oral fluconazole reserved for extensive disease, multiple sites, or treatment failures 7

Monitoring and Follow-up

• Clinical and mycological assessment should occur 3-4 weeks after completing treatment to confirm cure 1, 2
• If inadequate response is seen at weekly follow-up visits, additional weekly doses can be administered up to a maximum of 4 total doses 2
• Relapse rates are low (5% for tinea corporis/cruris, 15% for tinea pedis) when adequate treatment duration is completed 2