What is the recommended dose of fluconazole (PO) for a healthy adult female with an uncomplicated vaginal infection?

Fluconazole Dosing for Uncomplicated Vaginal Candidiasis

For an uncomplicated vaginal yeast infection in a healthy adult woman, give fluconazole 150 mg orally as a single dose. 1, 2

Dosing by Clinical Scenario

Uncomplicated Infection (Mild-to-Moderate, First Episode)

• Single dose: Fluconazole 150 mg PO once 1, 2
• This achieves >90% clinical response rates 1
• Equivalent efficacy to 7-day topical azole therapy 3, 4
• Clinical cure or improvement occurs in 94-97% of patients by day 14 3

Severe Acute Infection

• Fluconazole 150 mg PO every 72 hours for 2-3 total doses 1
• The multi-dose regimen achieves significantly higher cure rates in severe vaginitis compared to single-dose therapy (P=0.015) 5
• Superior clinical and mycologic eradication persists through day 35 follow-up 5

Recurrent Vulvovaginal Candidiasis (≥4 Episodes/Year)

Two-phase approach: 1

1. Induction phase: Fluconazole 150 mg PO every 72 hours for 3 doses OR topical azole for 10-14 days 1

2. Maintenance phase: Fluconazole 150 mg PO once weekly for 6 months 1, 6

   • Achieves disease-free status in 90.8% at 6 months vs 35.9% with placebo 6
   • Median time to recurrence: 10.2 months vs 4.0 months with placebo (P<0.001) 6
   • After stopping maintenance, expect 40-50% recurrence rate 1

Important Clinical Caveats

Non-albicans Species

• C. glabrata: Often resistant to fluconazole 1

  • First-line: Intravaginal boric acid 600 mg daily × 14 days 1
  • Alternative: Nystatin suppositories 100,000 units daily × 14 days 1
  • Multivariate analysis shows non-albicans species predict significantly reduced response regardless of therapy duration 5

• C. krusei: Intrinsically fluconazole-resistant but responds to all topical azoles 1

Treatment Failure Predictors

• History of recurrent vaginitis significantly reduces clinical and mycologic response (P<0.001) 3
• Patients with recurrent disease (33/84) respond less favorably than those without recurrence history (177/266) 3

Safety Profile

• Mild side effects in 27% (primarily gastrointestinal complaints) 3, 4
• Abnormal lab values occur in <10% but are clinically insignificant 4
• Contraindicated in pregnancy and lactation 7
• Drug interactions possible with astemizole, calcium channel blockers, warfarin, cyclosporine, protease inhibitors, and others 1

HIV Status

• Treatment dosing does not differ based on HIV status 1
• Identical response rates expected in HIV-positive and HIV-negative women 1