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Subject: 2nd try/diflucan/thrush/intro


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Subject: Difulcan/thrush thoughts & Intro

As as pharmacist & lactation consultant, I see thrush and It's treatment from
both sides of the counter.  I have a number of thoughts on the subject &
would like some feedback:

1) Seems to peak at the spring & fall season changes. shows up 2-3 weeks
postpartum,  after inital nursing speed bumps are worked out.

2) Many resistant cases may actually be do to ineffective application of
medication (nystatin solution).  Not often enough (smaller amt after every
feed, same total daily dose) , Not treating all areas (getting med down into
pocket between outside gum and fat pad in baby's cheeks, undertounge, roof of
mouth).  Not treated long enough (10+ days after all symptoms gone.) just to
name a few.

3) Mom not being treated at the same time. Seems to me in many cases mom is
showing symptoms (pain, itch, burn, dryness, cracks) 7-10 days or more before
baby does. And reappears 2-3 weeks after baby's treatment if it clears at
all.

4) Unrecognized cause? c-section mom's get antibiotics and most don't have a
clue they did. so no one believes it could be thrush.

What are your thoughts????

In my practice after we adjust for the above factors in resistant cases, if
mom is not getting a fair amount of relief between day 3-7 and resolution by
day 10 we speak to the dr about other meds.  Diflucan seems to work for us in
most cases (not in the vaginal 150mg dose) and baby must be treated
(nystatin) along with anything else that goes in baby's mouth or on moms
breasts (dont forget boiling, bottle nipples, pacifiers and favorite chew
toys, as well as cross infection procedures, washing hands)  There are 2 ways
I suggested-- (10) 100mg tablets--  200mg on day 1, 100 mg for the next 5
days and 50mg(1/2) for the next 6 days. or (13) 100mg tablets, 1 tablet daily
for each of 13 days.  If it is really thrush by the 3rd dose in both cases
mom & baby are both significantly better.  However, I have a fairly large
population from India where we have had one or 2 cases (one a pediatric
resident) that we had to up the doseage to clear it up.  There have been a
couple of moms with unexplained deep breast pain (one for almost 6 months)
that we used diflucan as a type of diagnostic tool by day 3-4 pain episodes
had dimished and by day 5 were completly gone.  Generally if it is yeast
relief should start by day three, if not other causes should be sough out.

Now to introduce myself.  I am a pharmacist by trade and a lactation
consultant by choice.  I started Breastfeeding Specialist Inc. in 1989 after
the birth of my 1st child (lots of probs--not much real help)  I have 2 girls
ages 4 & 8,   2 professions, 6 locations, 2 houses and a hunsband
(unfortunatley many times in that order).

I get drug calls from all over the country and am searching for others with
like backgrounds. Anyone have any medication suggestions for depressed moms
from mild to severe that seem to work for your area I'm all ears.

Thanks in advance

Anne F. Norton-Krawciw, RPh, IBCLC
Breastfeeding Specilists Inc
Sterling Heights MI

Favorite quote:  BREASTFEEDING:  If the cavewomen did it wrong, we wouldn't
be here.

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