Fluconazole Dosing for Fungal Infection on the Buttock
For a localized fungal infection on the buttock (perineal/cutaneous candidiasis), treat with fluconazole 150 mg once weekly for 2-4 weeks. 1
Clinical Classification and Rationale
This presentation represents cutaneous/perineal candidiasis, which requires a different treatment approach than vulvovaginal candidiasis or systemic infections. 1
Key Dosing Distinction
- Perineal/cutaneous candidiasis: 150 mg once weekly for 2-4 weeks 1
- NOT the single 150 mg dose used for uncomplicated vulvovaginal candidiasis 2, 3
- NOT the 200 mg daily dosing used for urinary tract infections 2, 3
Treatment Protocol
Weekly dosing regimen:
- Fluconazole 150 mg orally once weekly 1
- Duration: 2-4 weeks depending on clinical response 1, 4
- This approach achieves a 92% clinical cure rate for cutaneous candidiasis 1
Supporting Evidence for Cutaneous Infections
The weekly 150 mg dosing strategy is well-established for superficial fungal infections in the perineal/groin region:
- Studies of tinea cruris (jock itch) and tinea corporis demonstrate efficacy with fluconazole 150 mg weekly for 2-4 weeks 4
- This regimen significantly reduces clinical symptoms (pruritus, erythema, scaling) with good safety profile 4
- The pharmacokinetics support weekly dosing: fluconazole achieves high concentrations in the stratum corneum with a long elimination half-life 5, 6
Common Pitfalls to Avoid
Do not confuse this with vaginal candidiasis dosing:
- The Infectious Diseases Society of America explicitly distinguishes perineal infection from vulvovaginal candidiasis 1
- Single-dose therapy (150 mg once) is inadequate for cutaneous/perineal infections 1
Do not use daily dosing regimens:
- Daily dosing (200 mg daily) is reserved for urinary tract infections, not cutaneous infections 2, 3
- Higher daily doses (400 mg) are for systemic/invasive candidiasis 2