I have a mom who has been struggling with yeast since the baby DOB 4-22-02 was 2 wk old.  She had some cracks from a poor start with BF, then developed pain which was treated as mastitis, even tho she had no fever.  The first antibotic was erythromycin which made her very very  ill, so she stopped it after 5 days, pain continued so OB prescribed Keflex for 10d.  She took it for 4-5 days and stopped since the pain did not stop, and in fact got worse.  By now baby is 3 weeks old.    Baby had some thrush so nystatin was started and mom was not treated immediately.
Pain continued tho no visible signs on baby or mom after a few days on nystatin for the baby.  Mom was started on diflucan 100mg day1,  100mg  day3, and 100mg day 7.   No significant decrease in the shooting pains mom experienced.   So after 10 d, mom called hospital LCs who rec Hales regimen of 400mg for loading dose, the 200mg for 21 days.   And she made contact with me at that time.
   Now after 1 week on larger dose it seemed to be improving.  On 8th day, she was much worse, and in frustration took 400mg again, followed by 200.  Some improvement, then a week later another flareup.   Saw OB who now suggests 400mg q other d.
   She calls her pedi to check on this dose for effects on baby.  They tell her PDR info, and it scares her.  Next call is to pharmacist who says you have to stop BF or it will never clear up. (This makes no sense to me since vaginal yeast is ever present, and when women get a yeast infection, no one tells them to dry up their vagina or the yeast will persist...)
   So,  after another pep talk from me, and lots of info on treating the laundry, the baby's mouth and bottom, rinsing the breast after feeds with mild vinegar solution, she is going to go with the 400mg q other day, and 200mg on the alternate days.   She is very determined since she does not want to end the BF relationship, and baby is refusing all bottles.
  I have advised mom to take a nap daily.  To cont prenatal vit + 100 mg of zinc (for 7-14d only), and 250 mg vit C 2-3 xd.  She is avoiding more than 150 carbs per day(her older daughter has Type 1 diabetes so she can count carbs--says it has given her a new appreciation of her daughter!)
HELP.   Are we missing something?   Michelle Scott, MA,RD,IBCLC in NH

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