Hi
Today I talked with a mom who has had a second mastitis infection in a month (which leads me to believe that it is really one that never completely went away) and in the midst of talking to her I made a mental connection that I have not seen before and wanted to tap into the collective Lactnet wisdom for comment/reaction.
I've always told moms who have trouble with yeast infections about the balance in everybody of yeast and "good" bacteria, and when you do something to upset the balance, like taking an antibiotic that gets rid of good and bad bacteria indiscriminately, the yeast has a chance to run rampant and you end up with a yeast infection.
My question is, can you screw up the balance in the other way? This mom has had yeast infections in the past and was given diflucan (not sure when this happened, but apparently has been a while), and when she got mastitis 3 1/2 weeks ago the doctor prescribed both an antibiotic and diflucan simultaneously. I don't think the mom had any yeast symptoms, and am guessing that the doctor was prescribing the diflucan as a preventative. Mom took antibiotic for the 10 days and said she felt better but still not great at the end of the 10 days but gradually got better until a week ago when the mastitis flared up again. I'm not sure how long she took the diflucan, but I'm reasonably sure she took whatever course of it the doctor prescribed.
Is it possible that taking diflucan when a yeast infection is NOT currently a problem upsets the balance in the other way, perhaps lowering the tolerance threshold for good or bad bacteria and thereby increasing risk for another mastitis attack? Or at least making it more difficult to get rid of the initial infection?
I did find something in LLL's Breastfeeding Answer Book, p. 501, that almost "goes there":
"A study of 946 breastfeeding mothers in the United States (Foxman 2002) found the incidence of mastitis to be about half of the Australian studies--9.5 percent compared with 20 to 27 percent. The risk factors for mastitis in this group were: history of mastitis with a previous child, cracks and nipple sores in the same week as mastitis, USING AN ANTIFUNGAL NIPPLE CREAM WITHIN THREE WEEKS OF THE MASTITIS [emphasis mine], and use of a manual pump."
Another study that BAB quotes in the paragraph above has "use of a cream on the nipples (papaya cream was most commonly used)" as a risk factor.
So I wonder whether in the Foxman study, the risk is because the cream blocks the pores, or if it is because of the antifungal stuff in it--which could link it to diflucan use? Another off-the-wall thought--I don't suppose there is anything in papaya that acts as a natural antifungal?
Any thoughts? I did suggest to the mom that her milk may need to be cultured to make sure that the antibiotic she's taking is going to do some good. I'm writing a report to the doctor to that effect as well. This doctor, by the way, is probably the most supportive doctor in my area--she has breastfed her two kids and needed help with her second, which I was able to provide.
thanks!
Melissa Vickers, IBCLC
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