I would culture this mother's nipples and milk for yeast and bacteria.  I 
will send you a protocol I have developed.
You are correct 5 days of diflucan is not enough but she may also have a 
resistant staph infection of the ducts.The milk culture for yeast should have 300 
micrograms of ferrous sulfate added to each ml prior to being cultured to 
increase the yeast yield.  If the baby has any signs of thrush she should be 
placed back on the diflucan empirically but still culture for bacteria. Dont' 
forget that the baby should be treated as well for thrush.   Treat maternal pain 
with ibuprofen and or tylenol.  Chris Betzold NP IBCLC MSN

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