One reference that may help this Mom and her HCP feel more comfortable about
long term use of Diflucan is an article from JHL (Journal Human Lactation 13
(4), 1997, pp 307-11), "Long-Term Treatment of a Breastfeeding Mother With
Fluconazole-Resolved Nipple Pain Caused by Yeast: A Case Study" by Vicki Bodley
and Diane Powers.
Abstract:
This case follows a breastfeeding mother with cracked nipples undergoing
antibiotic treatment (dicloxacillin) for mastitis. Nipple candidiasis also
presented with burning, stinging pain radiating from the nipples into the breast,
lasting throughout feedings and beyond. Over a 7-week period, the symptomatic
infant was treated with the oral antifungal, nystatin. After other antifungal
treatment regimens (oral nystatin, tristatin ointment) had been deemed
unsuccessful for the mother, the physician prescribed fluconazole (200 mg loading dose
plus 100 mg/day for 15 days) which reduced, but did not eliminate, the nipple
yeast and accompanying pain. Fluconazole was continued for an additional 30
days (200 mg/day) for a total of 6 weeks of treatment with this medication.
Concurrently, a topical yeast medication (tristatin ointment) was used for a total
of 8 weeks on the nipples/areola, after which the overt pain was resolved.
Although mastitis resolved after 1 week, the cracked nipples did not completely
heal for several months. During the initial 3 weeks of treatment, neither
over-the-counter pain medication nor acetaminophen with codeine relieved this
mother's pain. Hydrocodone bitartrate and acetaminophen (10/650 mg tablet) (Lorcet)
offered the pain relief necessary for this mother to continue to breastfeed.
J Hum Lact 1997: 13:307-311
Hope this is helpful for this Mom. Also, I am concerned about the serial
nature of her treatments. Frequently this is like a general sending in the
infantry, pulling them out, sending in the cavalry, pulling them out, then sending in
the airborne troops, then pulling them out. (I am not always comfortable with
a war/battle analogy with its implied violence, but with persistent yeast
these seem to be appropriate analogies.) What you need is to throw everything at
the yeast for a sustained time.
A person knowledgeable in treating fungus used another analogy for me: you
need a sword (your antifungals such as Diflucan, GSE, GV, garlic, caprylic acid,
etc.) and a shield (probiotics) to help reduce the Candidiasis to commensal
status. So, I would suggest that she maintain a level of probiotics that
includes billions of live cultures and an array of the cultures, not just
lactobacillus acidophilus or bifidus. I would hope the HCP would feel more comfortable
prescribing Diflucan for a longer period of time after reviewing the JHL
article and seeing the information re: Diflucan in Medications and Mothers' Milk.
Additionally, nutritional support for the immune system to help battle this
overgrowth would be very helpful.
Warmly,
Ann Russell, IBCLC
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