Stabbing pain in the breast without a lump, bump or redness is not mastitis
and the mother should not be on dicloxacillin which only might make her
problems worse. The symptoms of Candidal infection are, besides sore
nipples, are this typical stabbing or shooting or burning pain in the
breast, unassociated with lumps bumps or redness, and the pain is typically
*late in the feeding or after the feeding is over* and worse in the evening.

Local treatment often works, either gentian violet (or as one of my patient
called it recently "genital violet") or all purpose nipple ointment (see one
possible recipe below and check rationale in Treatments for Problems at the
websites below). I usually will try both, using gentian violet once daily
(as in websites), and apno at all other feedings. This treatment often
works.

Pain in the breast could be referred pain from sore nipples.. But sometimes
mothers have the typical pain without any nipple soreness. Nevertheless, the
local treatment often works, don't ask me why.

Ketoconazole can be used instead of fluconazole. It's almost as good and a
lot less expensive. The dose is 400 mg stat dose, then 200 mg bid until the
mother is pain free for a week. I usually continue the apno, and also treat
the baby with gentian violet.

Jack Newman, MD, FRCPC

http://www.erols.com/cindyrn/drjack0.htm

or

http://www.bflrc.com/jn_arts.htm