On Tue, 26 Sep 2006 10:47:28 +0200, Carmela Baeza <[log in to unmask]>
wrote:
>Hello everyone,
>>>>>
>My first question was: is this really a yeast
>infection? By the symptoms and the look, it could be,
>and by the fact that it clears away with the
>treatment.
Since there does not seem to exist a sensitive test for determining whether
or not yeast is present AND pathogenic, it's certainly possible that this
mom does have a recurring problem with yeast. If it clears away with
treatment, by all means treat it! I have had good luck actually
visualizing the hyphae (maybe it's technically pseduo-hyphae?) in drops of
milk under microscopy, even without using a stain, which I figured, along
with a couple of other docs, was at least somewhat confirmatory. But if we
hadn't seen it, I don't think we would have said it wasn't yeast...
>My second question: how many times can a mom be
>treated orally with antifungicals? Would it be better
>to take a low dose for a longer time, like a
>prevention treatment? I know this is what I would
>recommend for a recurrent vaginal yeast infection, but
>I have no experience on the breast.
I personally took over an ounce of fluconazole over about a 5 month
period. My first yeast infection flared up at around 3 weeks postpartum;
finally started to get better after 2 weeks of 100mg qd and then 4 weeks of
200mg qd, but then it got much worse after starting several weeks of oral
antibiotics, and finally resolved after 3 weeks of 400mg qd (yes, 9
straight weeks of Diflucan). The yeast came back with a vengeance
following 3 subsequent courses of oral antibiotics, and each time I
immediately started taking 400mg of fluconazole a day as soon as I felt the
pain start up. The very last time required nearly 3 weeks again, but the
other flares I guess I caught earlier and resolved in 1-2 weeks. And as an
aside, within the next 6 months I needed 2 more courses of antibiotics
(sinusitis and mastitis again -- I swear I have never EVER taken so many
medications before in my life!), but the yeast did not recur for whatever
reason.
I recently saw the infectious disease doctor who was willing to prescribe
all the fluconazole for me, and she only half-jokingly suggested that I
start to take it prophylactically shortly after I deliver my next baby --
200mg once-weekly dosing was something we considered but never tried last
time. It probably wouldn't hurt to try with this mom.
>My third question: would the child require oral
>treatment to "break the chain"? Some authors say yes,
>but again, I have no experience and I would love some
>input.
Again, speaking only from personal experience here, during my initial
infection when I was still able to nurse directly sometimes, the
pediatrician willingly prescribed Nystatin drops and then oral fluconazole
for my son when it became clear that I was dealing with an unusually
persistent case of yeast. And I can't say for certain that it was what
worked to break the cycle because we started it at the same time I started
mega-doses of fluconazole, but the po fluconazole for my son DID seem to
help ME feel better. Later on I had to pump exclusively so we didn't
bother treating him.
It's not well-researched or supported by evidence one way or the other, but
if you weigh the risks and benefits of giving the little one treatment, you
and mom may decide to go ahead and try it.
Good luck to this mom! Having never had any other kind of yeast or fungal
infection, I was shocked how susceptible I seemed to be and really how
terrible the resulting pain was.
-Sarah Reece-Stremtan M.D.
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
