Please write an oral fluconazole order for acute vulvovaginal candidiasis in a patient without hepatic disease or interacting medications.

Fluconazole Order for Uncomplicated Vulvovaginal Candidiasis

Order fluconazole 150 mg orally as a single dose. 1, 2, 3

Prescription Details

Medication Order:

• Drug: Fluconazole 150 mg tablet
• Route: Oral (PO)
• Dose: 150 mg
• Frequency: Single dose (one-time administration)
• Quantity to dispense: 1 tablet
• Refills: 0 3

Clinical Rationale

This single-dose regimen is the standard of care for uncomplicated vulvovaginal candidiasis, achieving >90% clinical response rates. 1, 2 The Infectious Diseases Society of America (IDSA) 2016 guidelines establish this as first-line therapy, and the FDA-approved labeling confirms 150 mg as the recommended dosage for vaginal candidiasis. 1, 3

Why This Dose Works

• Single 150 mg oral dose achieves equivalent efficacy to multi-day topical azole therapy 1, 4
• Clinical cure or improvement occurs within 5-16 days in 95-97% of patients 5, 4
• Mycological eradication rates reach 85-93% at short-term follow-up 6, 4
• Patient preference strongly favors oral single-dose over topical multi-day regimens 7

When This Order Applies

Use this regimen only for uncomplicated vulvovaginal candidiasis, defined as: 1

• Mild-to-moderate symptoms (pruritus, discharge, dysuria)
• Sporadic or infrequent episodes (not recurrent)
• Likely Candida albicans infection
• Immunocompetent host (no HIV, uncontrolled diabetes, or immunosuppression)

When NOT to Use This Order

Do not use single-dose fluconazole if: 1, 2

• Severe symptoms (extensive vulvar erythema, edema, excoriation, fissures) → requires fluconazole 150 mg every 72 hours for 3 doses (total 450 mg over 6 days) 1, 5
• Recurrent infection (≥4 episodes per year) → requires induction therapy followed by maintenance fluconazole 150 mg weekly for 6 months 1, 8
• Non-albicans species suspected (treatment failure, prior azole exposure) → may require alternative therapy 1
• Pregnancy → fluconazole is not recommended; use topical azole instead 7

Critical Safety Considerations

Drug interactions to verify (even though patient has "no interactions"): 1

• Warfarin (increased INR risk)
• Oral hypoglycemics (hypoglycemia risk)
• Phenytoin (toxicity risk)
• Calcium channel blockers
• Protease inhibitors
• Tacrolimus/cyclosporine

Hepatic monitoring: 1

• While you've confirmed no liver disease, be aware that fluconazole rarely causes transaminase elevations
• No baseline labs needed for single-dose therapy in healthy patients

Follow-Up Instructions for Patient

Instruct the patient to: 5

• Expect symptom improvement within 5-16 days
• Return if symptoms persist beyond 5-7 days or worsen
• Return if symptoms recur within 2 months (requires re-evaluation and cultures)
• Avoid self-treatment with over-the-counter preparations if symptoms return

Common Pitfalls to Avoid

Do not treat without confirming diagnosis: 2, 5

• Symptoms of pruritus and discharge are nonspecific
• Ideally confirm with wet mount (10% KOH showing yeast/pseudohyphae) and vaginal pH ≤4.5 before prescribing
• If wet mount negative but symptoms persist, obtain vaginal culture

Do not treat asymptomatic colonization: 5

• 10-20% of women harbor Candida without symptoms
• Treatment not indicated for positive culture without symptoms

Recognize treatment failure patterns: 5

• If patient fails this regimen, consider non-albicans species (C. glabrata, C. krusei)
• C. glabrata requires alternative therapy: boric acid 600 mg intravaginal daily for 14 days or nystatin suppositories 1, 2