Magda wrote about flucanazole:

>
>Can I just point out that the dosages mentioned came from our Breastfeeding
>Network leaflet which is for use in the UNITED KINGDOM.  We looked at
>literature for the dosages we suggested and know of some in the UK who are
>using higher dosages.  My co-author (a pharmacist as well as a Breastfeeding
>Supporter) and I constantly review what we are doing.  We are aware of
>concerns of resistence, but the situation in our population may differ in
>some ways.  When we wrote the leaflet we knew we were doing something a bit
>controversial, but I cannot describe the amount of hassle, flack and
>vituperation we have taken on the chin for the past three years over this.
>If we had suggested a higher dose of Fluconazole or dared raise the issue of
>gentian violet at the same time (we were the first to publish in the UK
>about use of fluconazole and involved in the first wave of publicity about
>thrush in breast feeding) both of us might now be recovering in a
>sanitarium!!


I'd echo this. Thrush on the nipples and in the breast in the UK is
in an entirely different situation. Most UK doctors - who are the
only people here who can prescribe (ok, there are a few nurse
practitioners, but only a few) anti-fungals have not heard of the
condition affecting the breasts/nipples, and many of them do not
believe it exists. I know this, because I lecture to medics from time
to time, and I deal with mothers who have (what I feel) are symptoms
which could well be thrush, and they may have enormous difficulty
getting their doctors to take this possibility on board. I send them
references to share, and I encourage them to involve their midwife or
health visitor in treatment - m/ws and HVs are more open to the idea
and are more likely to have heard of thrush in these places.

Mothers can buy topical anti-fungals over the counter, but they are
expensive, and their pharmcist may advise them against it.
Flucanazole is not licensed for lactating mothers, which is another
barrier to getting it.

There is no way a mother would ever get gentian violet for this use
in the UK, and I have never suggested it.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK

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