From: coleb                Tue May 21, 1996 -- 01:05:47 PM
To: [log in to unmask]@

Cyanne -

Funny you should ask this about the OTC antifungal use for nipple thrush.  I
just asked Dr. Hale through E-mail about it because so much has been written
on thrush the last few months I figured I had missed it.  He told me that he
has "heard" that people are using miconazole cream as an OTC cream for mom's
nipples, but that he is not recommending its use.  He said it is poorly
absorbed topically, and the oral absorption is 25% of the dose.  The fact
that he would not recommend its use for nipple thrush makes me a little
nervous about it.  The reason I asked about it is because our OB's are
refusing to order Nystatin or other Rx because they don't know if nipple
thrush is a *real infection*, since they didn't learn about it in medical
school.  How they can look at me when I am describing their pt's severe
nipple pain and my assessment of thrush and tell me they aren't going to
order something BECAUSE THEY DON'T NORMALLY DO THAT . . . IT IS BEYOND ME!!!!
(YES, I AM YELLING!)  A peds nurse practitioner (who is sitting for the IBCLC
boards this summer) and I are doing a presentation to the OB's and
pediatricians at their joint monthly meeting next month to "teach" them about
thrush and to decide who is going to be responsible for writing the mom's
prescription.

Barb Cole, RN, IBCLC
(It's sunny and warm here in central Wisconsin today, in the 80's.
Apparently spring wasn't interested in showing its face so we just jumped
into summer.  I'm not complaining!)