Barbara Wilson-Clay's pithy post on thrush was very welcome.  It is a
nebulous entity.  When I see mothers with infected-looking nipple fissures,
even the kind described in several sources as typical for thrush, that go
around the base of the nipple shaft where it joins the areola, I take
cultures.  Nearly always they are positive for s.aureus, which is nearly
always penicillinase-producing.  Very occasionally they will also be
positive for yeast; in these cases there has always been a symptomatic baby,
and usually a course of antibiotics in either mother or baby or both, prior
to outbreak of symptoms.

The problem most bothersome to me now is that the Norwegian reference work
on drugs and breastfeeding, which is otherwise excellent, states that
fluconazole should not be used while breastfeeding because it passes into
the milk in 'large' amounts.  The fact that it is a drug appropriate for use
by premature infants is not mentioned, and we have numerous cases of women
whose doctors have, understandably, been hesitant to prescribe it for them
even when they have very persistent and painful, well-documented cases of
thrush.

Rachel Myr
Kristiansand, Norway

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