## Drug of Choice for Vulvovaginal Candidiasis **Key Point:** Fluconazole is the first-line azole antifungal for uncomplicated vulvovaginal candidiasis caused by *Candida albicans*. ### Mechanism & Efficacy Fluconazole is a triazole that inhibits fungal lanosterol 14α-demethylase, disrupting ergosterol synthesis in the fungal cell membrane. It achieves excellent vaginal tissue penetration and high local concentrations, making it ideal for mucosal candidiasis. ### Dosing & Administration - **Single-dose regimen:** 150 mg oral fluconazole (most common, highest compliance) - **Alternative:** 100 mg daily for 3 days - Cure rates: 80–90% for uncomplicated cases ### Why Fluconazole Over Alternatives | Feature | Fluconazole | Amphotericin B | Terbinafine | Griseofulvin | |---------|------------|----------------|------------|---------------| | Route | Oral | IV/topical | Oral | Oral | | Candida coverage | Excellent | Excellent | Poor | Poor | | Vaginal penetration | High | Low (IV) | Moderate | Poor | | Side effects | Minimal | Nephrotoxic, infusion reactions | GI upset, hepatotoxicity | Photosensitivity | | First-line status | Yes | Reserved for severe/systemic | No | No | **High-Yield:** Fluconazole is preferred because it is oral, well-tolerated, achieves therapeutic vaginal levels, and has a proven high cure rate with a single dose. It is the standard of care in India and globally for uncomplicated vulvovaginal candidiasis. **Clinical Pearl:** In recurrent vulvovaginal candidiasis (≥4 episodes/year), fluconazole prophylaxis (150 mg weekly for 6 months) is recommended after initial treatment. [cite:Tripathi KD 8e Ch 51]
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