I had a call from a mom yesterday w/ a 5 wk old exclusively bf baby. She
told me that baby had thrush in mouth and she had thrush on breast so docs
were treating her with nystatin cream and baby with nystatin suspension. She
improved at first, but then developed a crack at one nipple base which is
extremely painful and not healing. Baby still has some thrush in mouth and
the nystatin tx is continuing for both. She asked for advice what to do
next.

I discussed options for care including general thrush measures, use of a
different antifungal cream or ointment including OTC meds, a Dr. Jack style
nipple ointment (antifungal, antibiotic, cortisone compound), systemic
antibiotic treatment (like the journal club article suggests), and doing
milk expression on affected side if needed til healing began.

My question to you all is: in light of the persistant thrush, would the
sytemic antibiotics exacerbate the problem and increase thrush probability?
Would you feel that the systemic treatment is warranted and maybe add a
systemic yeast med as well? Of course this has to be addressed w/ her doctor
and prescribed by him. Thanks.

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA

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