Jan

Sorry, that your first diflucan treated couple, had the baby break out in
hives,  I personally do not think it was the diflucan.  Having  observed the
treatment of many, many, many mother baby pairs with diflucan in the past
couple of years.  We  have not had one adverse reaction.  Has she eaten
banana's since the incident. or were there other holiday type foods that she
may have eaten - hidden nuts etc.

Both of my girls and myself have broken out in mystery hives at the oddest
times with no known cause, yes even when they were totally nursed. Could not
link it to any food, med etc.  What i did find is that if they were over
bundled it was much worse and that only time (sometimes a very long time)
would make them go away and stay away.  The longest bout lasted almost 5
days. My entire family has a very strong history of allergies.  My youngest
had her last attack on the way driving to ILCA this past summer. We were
still eating and drinking all foods packed from home and she started to
breakout just after we left the grand canyon.  This made for a very long (4
hours +) and scary trip to the scottdale emergency department.  Again no
identifiable cause and the only cure was time even high doses of benadryl
didn't touch it just made her sleep.

Another side of hives, my oldest would break out after spending alot of time
being cuddled and held by her grandmother who just loved putting on toooo
muuuccccch loves baby soft colone, grandma was starting to get a complex.
suggested that she not wear the smelly stuff  (made the baby sneeze,) and the
problem dissappeared.

Diflucan dosage:  We have used (13) 100mg tablets-- 200mg the first day and
100mg daily until gone. depending on how long mom has had the problem and how
bad the baby is, mom may need an extra 7 to 10 days.  ((Please note that the
insert for diflucan states that it is excreted into milk , so nursing is not
recommended--- IT DOES NOT SAY THAT IT IS CONTRAINDICATED )).

I have also used a (10) 100mg tablet dosing that was 200mg day 1, 100mg for
the next 5 days and 50 mg for the next 6 days. I found that complience was
better if mom did not have to cut tablets and remember what day of treatment
she was on. With both protocols, It may take 3 to 5 days before true relief
is seen, but i have had moms get some relief in as little as 12 hours after
the first dose.

Is not the only way to get the drug into the inside of the ducts is to have
the drug be in the milk and tissues in and around the milk. If we can give it
safely to babies directly, what is the real chance that the small amount
passed through mom's milk will cause true harm.

MOM & BABY NEED TO BE TREATED TOGETHER.(yes i am shouting) for up to 10 days
to 2 weeks past symptoms.  How was the mom applying the nystatin???? after
every feed or just 3-4 times per day, just squirting it into the babys mouth,
or swabbing it all over and giving the baby the remainder.

If mom takes diflucan orally, all the baby may need is to have the nystatin
applied properly, and often enough, for long enough.  If not diflucan oral
suspension has been approved for thrush treatment for babies directly.  The
insert says babies 6 months and up (in my pharmacy practice i have seen
babies as young as one month old being treated directly for thrush (from the
same pedies who used to have moms crush the tablets up to make a paste and
apply the paste to the baby's mouth for 3 days-- before the suspension was
approved.)

I understand that diflucan has a established safety profile down to 1 day of
age. (tom correct me if I am wrong)  The last dosing that i got from the drug
rep was 6mg/kg on day one and 3mg/kg for 5-7 days total dosing.  As it has
been stated on the net before they routinely use this medication on sick
babies in the NICU.

Pharmasist side thought:  I don't want to see this medication overused when
other more simple meds & /or methods tried first and used correctly will do
the job. Lest we end up with very resistant yeast, like has happened with
bacteria due to the overuse of antibiotics.

I will be happy  to answer any other questions you may have by private
e-mail.

Anne Norton-Krawciw, RPh, IBCLC
(the Lactation Consultant - Pharmacist)

Breastfeeding Specialists Inc
Sterling Hts MI USA

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