Is fluconazole (Diflucan) contraindicated in a healthy living kidney donor with a vaginal yeast infection who will undergo nephrectomy in 16 days?

Fluconazole is NOT Contraindicated in Living Kidney Donors Before Nephrectomy

A single 150 mg oral dose of fluconazole is safe and appropriate for treating vaginal candidiasis in a healthy living kidney donor 16 days before scheduled nephrectomy, with no contraindications related to the upcoming surgery. 1

Treatment Recommendation

Administer fluconazole 150 mg orally as a single dose immediately after diagnostic confirmation. 1 This regimen:

• Achieves clinical cure rates exceeding 90% in immunocompetent women 1, 2
• Provides mycological eradication in 72-93% of patients at short-term follow-up 1, 3
• Clears the infection well before the surgical date, with therapeutic vaginal concentrations sustained for sufficient duration 2
• Carries minimal risk of clinically significant adverse effects that would impact surgical candidacy 1

Diagnostic Confirmation Required Before Treatment

Before prescribing fluconazole, confirm the diagnosis by: 1

• Wet mount with 10% KOH to visualize yeast or pseudohyphae 1
• Vaginal pH measurement: pH ≤4.5 supports candidiasis; pH >4.5 suggests bacterial vaginosis or trichomoniasis 1
• Vaginal culture if wet mount is negative but symptoms persist 1

This step is critical because symptoms alone (pruritus, discharge, dysuria) are nonspecific and present in only ~50% of patients who self-diagnose yeast infection. 1

No Surgical Contraindications

Fluconazole does not interfere with donor nephrectomy because:

• The 16-day interval is more than adequate for drug clearance; fluconazole has a half-life of approximately 30 hours, meaning it will be eliminated from the body within 5-7 days 4
• No renal dose adjustment is needed for single-dose therapy in patients with normal renal function 4
• Perioperative antibiotic prophylaxis (typically cephazolin started before incision and continued 24 hours post-operatively) is standard for donor nephrectomy and is not affected by prior fluconazole use 5
• No documented interactions exist between fluconazole and standard perioperative medications used in donor nephrectomy 1

Management of Severe or Treatment-Resistant Infection

If the patient presents with severe vulvovaginal candidiasis (extensive erythema, edema, excoriation, or fissures):

• Fluconazole 150 mg every 72 hours for 2-3 doses (total 450 mg over 6 days) 1
• This extended regimen still allows complete treatment 10 days before surgery

If symptoms persist beyond 5-7 days or recur within 2 months:

• Obtain vaginal culture to identify non-albicans species such as Candida glabrata or C. krusei 1
• For confirmed C. glabrata: boric acid 600 mg intravaginal capsules daily for 14 days (compounded) 1
• Alternative: nystatin 100,000 units intravaginal suppositories daily for 14 days 1

Drug Interaction Considerations

While fluconazole has important drug interactions, none are relevant to this clinical scenario: 1

• Warfarin: Fluconazole potentiates warfarin and increases INR; however, healthy kidney donors are not anticoagulated 1
• Oral antidiabetics: May enhance hypoglycemic effects; not applicable to healthy donors 1
• Calcineurin inhibitors: Fluconazole increases levels; however, donors do not receive immunosuppression 1

Common Pitfalls to Avoid

• Do not treat without diagnostic confirmation: Empiric treatment without microscopy leads to misdiagnosis in >50% of cases 1
• Do not delay treatment: The 16-day window provides ample time for complete resolution before surgery; delaying treatment unnecessarily prolongs symptoms 1
• Do not use topical therapy preferentially: While topical azoles are effective, single-dose oral fluconazole offers equivalent efficacy with superior convenience and patient preference 1, 6
• Do not withhold treatment due to surgical concerns: There is no evidence that fluconazole administered 16 days before nephrectomy poses any risk to the donor or surgical outcome 4, 5