What is the recommended dose and duration of Diflucan (fluconazole) for an adult female patient with an uncomplicated vaginal yeast infection?

Diflucan Dosage and Duration for Vaginal Yeast Infection

For uncomplicated vaginal yeast infection, take a single 150 mg oral dose of fluconazole (Diflucan) once—this is the standard treatment that achieves >90% cure rates. 1, 2

Uncomplicated Vaginal Candidiasis (90% of cases)

Standard Treatment:

• Single dose: Fluconazole 150 mg orally, taken once 1, 2
• Clinical improvement typically occurs within 24-72 hours 3
• Complete resolution expected within 7-14 days 3
• This single-dose regimen is as effective as 7 days of topical azole therapy 1, 4

Severe Acute Vaginal Candidiasis

Extended Treatment:

• Fluconazole 150 mg every 72 hours (every 3 days) for a total of 2-3 doses 1
• This regimen achieves superior clinical and mycologic cure rates compared to single-dose therapy in severe cases 5
• Severe disease is defined by extensive vulvar erythema, edema, excoriation, and fissure formation 1

Recurrent Vulvovaginal Candidiasis (≥4 episodes per year)

Two-Phase Approach:

Phase 1 - Induction (10-14 days):

• Fluconazole 150 mg every 72 hours for 2-3 doses, OR
• Topical azole therapy for 7-14 days 1

Phase 2 - Maintenance (6 months):

• Fluconazole 150 mg once weekly for 6 months 1, 6
• This maintenance regimen keeps 90.8% of women disease-free at 6 months (versus 35.9% with placebo) 6
• After stopping maintenance therapy, median time to recurrence is 10.2 months 6

Special Considerations for Non-Albicans Species

C. glabrata infections (often azole-resistant):

• Fluconazole may fail; consider alternative therapy 1
• Boric acid 600 mg intravaginal capsules daily for 14 days (first-line alternative) 1
• Nystatin 100,000 units intravaginal suppositories daily for 14 days (second-line) 1

C. krusei infections:

• Intrinsically resistant to fluconazole 1
• Use topical azole agents or boric acid 1

Common Pitfalls to Avoid

• Do not extend single-dose therapy to multiple doses for uncomplicated cases—this provides no additional benefit and increases cost 5
• Do not assume treatment failure before 72 hours—symptom relief takes 24-72 hours even with successful therapy 3
• Do not use single-dose therapy for severe disease—these patients require 2-3 doses for adequate cure rates 1, 5
• Obtain vaginal culture if symptoms persist or recur within 2 months—this identifies non-albicans species requiring alternative therapy 1
• Women with recurrent vaginitis have significantly lower cure rates (33/84 vs 177/266) and may need the extended regimens from the start 4

Drug Interactions and Side Effects

• Fluconazole is generally well-tolerated with mild gastrointestinal side effects (nausea, abdominal pain, headache) occurring in <27% of patients 1, 4
• Important drug interactions include: warfarin, oral hypoglycemics, phenytoin, calcium channel blockers, and protease inhibitors 1
• Rarely causes elevated liver enzymes 1
• No serious adverse effects reported in clinical trials 5

Treatment Does Not Differ Based On:

• HIV status—identical response rates expected in HIV-positive and HIV-negative women 1
• Pregnancy status is not addressed in these guidelines—consult obstetric guidelines for pregnant patients 1