Hello everyone,
I have permission to post about a mom who has just
come to my office with a case of resistant thrush.
This mother has a 15 month old nursing toddler.
Her first yeast infection was at 5 months post partum,
after taking antibiotics for mastitis. This episode
resolved with topic miconazol. A few weeks later she
had another yeast infection which also resolved with
topical treatment. The next one was treated with
topical mupirocin, and also passed. On one of the next
recurrences she was advised by another LC to take oral
fluconazol, and she was much better for a month or so,
when she had another recurrence. She got in touch with
Dr. Newman, who advised another round of fluconazol at
higher dose, and topic APNO. She has been well for a
month and a half after that, but now the symptoms are
back.
Her child has never had thrush symptoms, but since
this is not diagnostic she has received topic
treatment too.
The mom (who is an MD and has her own lactation web
page) is at a loss for what to do now. The pain is
back. Her nipples look reddish and dry, eccema-like.
My first question was: is this really a yeast
infection? By the symptoms and the look, it could be,
and by the fact that it clears away with the
treatment.
My second question: how many times can a mom be
treated orally with antifungicals? Would it be better
to take a low dose for a longer time, like a
prevention treatment? I know this is what I would
recommend for a recurrent vaginal yeast infection, but
I have no experience on the breast.
My third question: would the child require oral
treatment to "break the chain"? Some authors say yes,
but again, I have no experience and I would love some
input.
Thanks in advance from a "rookie" IBCLC!
Kika
Kika Baeza, MD, IBCLC, family doc
www.centroraices.com
Madrid, Spain
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