## Drug of Choice for Vulvovaginal Candidiasis **Key Point:** Fluconazole is the first-line systemic antifungal for uncomplicated vulvovaginal candidiasis in non-pregnant women. ### Rationale for Fluconazole 1. **Mechanism & Spectrum** - Azole (triazole) that inhibits fungal lanosterol 14α-demethylase - Excellent activity against *Candida albicans* (the causative organism in >90% of cases) - Good vaginal tissue penetration and bioavailability 2. **Dosing & Efficacy** - Single oral dose of 150 mg achieves >90% cure rate - Convenient, patient-compliant regimen - Oral absorption unaffected by food or gastric pH 3. **Safety Profile** - Well-tolerated with minimal side effects - No significant drug–drug interactions at standard dosing - Pregnancy category C (avoid in first trimester; topical agents preferred in pregnancy) ### Comparison with Alternatives | Agent | Route | Use Case | Limitation | |-------|-------|----------|------------| | **Fluconazole** | Oral/IV | Uncomplicated VVC, systemic candidiasis | Teratogenic in first trimester | | Amphotericin B | IV/Topical | Severe/invasive candidiasis, immunocompromised | Nephrotoxic; reserved for serious infections | | Terbinafine | Oral | Dermatophyte infections (tinea) | Not effective against *Candida*; used for nails/skin | | Griseofulvin | Oral | Dermatophyte infections (tinea capitis, corporis) | Ineffective against *Candida*; requires prolonged therapy | **High-Yield:** For uncomplicated VVC in non-pregnant women, fluconazole 150 mg single dose is the standard of care. Topical azoles (clotrimazole, miconazole) are alternatives for mild disease or pregnancy. **Clinical Pearl:** Recurrent VVC (≥4 episodes/year) warrants investigation for diabetes, HIV, or other immunosuppression; prophylactic fluconazole may be considered after exclusion of non-albicans species. [cite:KD Tripathi 8e Ch 57]
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