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Subject:
From:
Barbara Wilson-Clay <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 7 Jun 2002 08:04:30 -0500
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I doubt seriously that this mother has persistent yeast.  She's prob.
feeling slightly better on huge loading doses of diflucan because it prob.
also has some mild antibiotic activity (much in the same way that some
antibiotics may also have some antifungal properties -- mupirocin comes to
mind).  The history tells the story.  Mom's cracks developed in the first
weeks postpartum when nosocomial bacterial are most likely to be the causal
agents for mastitis.  You can have mastitis with no sx of fever.  I see this
fairly frequently.  Sometimes the mom is masking it because she is taking
ibuprofen for pain, and sometimes she is the type person who rarely runs a
fever when she has other types of infection (sinuses, etc).

  Lisa Amir's article in JHL talked about using pain rather than febrile sx
per se as a better diagnostic indicator of mastitis for this very reason.
(Maybe Lisa can chime in here, as she is expert on mastitis and on yeast.)
Your case mom was given two antibiotics that would not be many people's
first choice when it comes to treating mastitis.  She didn't stay on either
for the required full 10 days of tx to clear mastitis -- esp. if she picked
up a virulent hosptital strain.  She prob. has a low-grade mastitis that
flares everytime her immune system gets taxed (fatigue, stress, etc).  I'm
not saying she may not also have some issues with yeast, but if you treat
appropriately for something and it doesn't get better, logic forces one to
reconsider the diagnosis and try a different approach.  Unfortunately,
people become so phobic about antibiotics (fearing that it will cause yeast)
that they don't treat infections thoroughly, and then they become chronic.
I've seen a lot of exhausted, border-line ill moms throw in the towel after
weeks and months of extra laundry duty and hocus-pocus when 10 days of an
effectively dosed abx would have kept them breastfeeding.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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