>cond: as ped APN, if it is early thrush   (not long standing and
>complicated) first I offer gentian violet (no problem with Mexican moms who
>use "violetta" on everything :-)  If American mom balks at using "violetta"
>then I give the baby diflucan and mom
>ystatin cream or APNO.  Usually works fine.  If mom is in need of diflucan
>herself, I ref to her primary care provider with specific request for what
>she needs.

i have worked with MANY moms in the past year alone who have been on
diflucan, all sorts of topicals, jointly treating baby and mother, for
seemingly persistent cases of thrush.  they are at their wits end - with NO
relief from these approaches when they finally decide to try gentian violet
(few women seem keen to try it as a first line offense) and their symproms
COMPLETELY disappear within days.  I am now reticent to rule out thrush
just because topicals or diflucan doesn't work - although i know that is
one common wisdom, that if antifungals don't improve the pain, it probably
isn't fungal. ANyone else have this experience?  could it be that the
gentian violet is helping with a bacterial infection of the nipples, and
that it isn't fungal at all, hence the other antifungals not working?  or
is it just that there are lots of resistant fungi out there that gentian
violet still nails?  any thoughts?
Lyla Wolfenstein
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