Speaking only from personal experience here, but I took massive
amounts of fluconazole for an extremely persistent breast yeast
infection.  Started when my son was almost 4 weeks old and took it for
almost 9 weeks straight (2 weeks at 100mg/day, 4 weeks at 200mg/day,
then 3 weeks at 400mg/day once I started antibiotics and it got
worse.)  This actually *worked* for me, and my ped's office was not
concerned by the amount my little guy was getting; they were just
happy he was still getting my milk.  DS also took Diflucan for the
last 3 weeks as well.  My doc (ID specialist) just checked my liver
enzymes a couple months later after I'd taken a couple more shorter
but high-dose courses when the yeast recurred with subsequent
antibiotic use.

So I can't really speak to the "safety" of long-term Diflucan use, but
I can only share that it seemed to work for us!  And yes, the ID doc
was just as pleased and surprised as anyone when it finally cleared up
the first time -- she couldn't believe that it really was yeast and
that it would take that long, but starting immediately 400mg/day when
it flared the later times resulted in much quicker resolution of
symptoms (2-3 weeks instead of 9).

And on a somewhat related subject, what is the official consensus on
trying to look at breastmilk under a microscope or culture it to check
for yeast?  My OB originally looked at a drop of my milk and said, "Oh
yeah, that's yeast!" and then I finally looked at a drop myself during
my last infection and saw a few hyphae.  Does anyone ever do this, and
has there been any research on it?

Sarah Reece-Stremtan, M.D.
Washington DC

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