Fluconazole Single-Dose Therapy for Uncomplicated Vulvovaginal Candidiasis
The recommended single oral dose of fluconazole for uncomplicated vulvovaginal candidiasis is 150 mg taken as one tablet. 1, 2
Standard Dosing Regimen
A single 150 mg oral tablet is the FDA-approved dose for uncomplicated vaginal yeast infection in non-pregnant adult women without fluconazole allergy or severe hepatic impairment. 2
This single-dose regimen achieves clinical cure rates exceeding 90% and mycological eradication in 72–93% of patients at short-term follow-up (5–16 days post-treatment). 3, 4, 5
The 150 mg dose provides efficacy comparable to multi-day topical azole therapy while offering superior convenience and patient preference. 3, 6
Clinical Efficacy Data
Clinical cure or improvement occurs in 94–99% of patients at 14-day evaluation following the single 150 mg dose. 6, 5
At long-term assessment (27–62 days), clinical cure rates of 88–93% are maintained. 4, 5, 7
Symptom relief occurs more rapidly with oral fluconazole compared to intravaginal clotrimazole regimens. 7
When Single-Dose Therapy Is Inappropriate
Do not use the single 150 mg dose for:
Severe acute vulvovaginal candidiasis (extensive erythema, edema, excoriation, or fissures): requires fluconazole 150 mg every 72 hours for 2–3 doses (total 450 mg over 6 days). 3, 8
Recurrent vulvovaginal candidiasis (≥4 episodes per year): requires induction with fluconazole 150 mg every 72 hours for 3 doses, followed by maintenance therapy of 150 mg once weekly for 6 months. 3, 8
Pregnancy: only 7-day topical azole regimens are recommended; oral fluconazole is contraindicated. 3
Critical Diagnostic Confirmation Before Prescribing
Perform wet-mount microscopy with 10% potassium hydroxide to visualize yeast or pseudohyphae before prescribing the 150 mg dose. 3
Measure vaginal pH; pH ≤4.5 supports candidiasis, whereas pH >4.5 suggests bacterial vaginosis or trichomoniasis requiring different treatment. 3
If wet mount is negative but symptoms persist, obtain vaginal culture to confirm diagnosis and identify non-albicans species. 3
Empiric treatment without diagnostic confirmation leads to misdiagnosis in >50% of cases. 3
Common Pitfalls to Avoid
Do not treat asymptomatic Candida colonization: 10–20% of women harbor Candida without symptoms, and treatment is not indicated. 1, 3
Do not prescribe single-dose therapy for severe or recurrent disease: extended regimens are required for adequate clinical response. 3, 8
Do not ignore treatment failure: persistent symptoms beyond 5–7 days or recurrence within 2 months warrants vaginal culture to identify non-albicans species such as Candida glabrata, which is frequently azole-resistant and requires alternative therapy (boric acid 600 mg intravaginal capsules daily for 14 days). 3, 8
Safety Profile
The single 150 mg dose is well tolerated with minimal adverse events. 2, 4, 9
Most common treatment-related adverse events are mild gastrointestinal symptoms (diarrhea, nausea) occurring in <2% of patients. 9
Transient elevations in liver transaminases are rare with single-dose therapy; baseline liver testing is not required in patients without known hepatic disease. 3