what i see as the reasons for reluctance to prescribe fluconazole are:

 no one uses gentian violet (i do, usually before i refer a mom for
fluconazole unless she chooses not to use GV);

a true and unwavering belief that nystatin works (yeah, it works, the mom
weans in despair and the thrush then goes away);

 the terrific expense of fluconazole and the refusal of some insurance
companies to cover it (this can also be why some doctors believe one dose is
enough);

 and a terrible fear of side effects of fluconazole (could easily be cured by
simply reading the literature, that is, tom's books, but that usually doesn't
happen unless i send a copy).

so what are the reasons? ignorance, money, ignorance, and a core belief that
breastfeeding is not important enough to either know the current treatments
or believe that they are worth even large amounts of money.

carol brussel IBCLC

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