This is a tough situation.  I'm assuming that you are acting in the role
as an IBCLC, not a La Leche Leader?  If you are an LLLL, there is a
specific protocol for dealing with these cases.  Still, LLL has some useful
ways to manage this.  First, I do not think you overstepped your practice
boundaries as and IBCLC.  It is completely appropriate to provide articles
and references to back up your "recommendation."  Very bluntly stated...the
PDR is not a reliable source for checking drugs for lactating women.  The
PDR would have us believe that it is safer for mothers and babies to wean
and go to formula than to ingest anything (maybe even air) and continue
breastfeeding.  It is purely to limit their own (pharmaceutical companies')
liability.  The PDR is actually just a giant collection of advertisements
and it is not the source that most pharmacists use (The Red Book being one
of the better).  The two printed sources that are recognized in lactation
are Briggs and Hales.  Anderson (from UCSD) also has a phone-help line for
doctors wanting to check meds.  It sounds like the doctor is threatened by
your challenging him and that he may just be too lazy to make the effort
because he isn't convinced that bf matters.  There is increasing literature
in mainstream medical journals that fluconozole is not effective as one or
two doses in non-vaginal C. Albicans, nor is it effective in some of the
the other strains.
        Now, as for fluconozole being a problem...ASK THIS DOCTOR WHY IT IS
OKAY TO GIVE FLUCONOZOLE TO PREMIES AND NOT TO MOTHERS NURSING BABIES?

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Briggs GG, Freeman RK, Yaffee SJ.  Drugs in Pregnancy and Lactation 4th ed.
Phil, PA:          Williams & Wilkins, 370-371; 1994.
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33: 440-441, 1964.
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33: 701; 1991.
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Phil, PA: Mosby Co.: 264-265, 492-94; 1994.
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Stubborn."  Patient Care, 16-44; Jan. 30, 1994.

: )Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC  email: [log in to unmask]   : )
: )HSR & Health Educational Consultant        voice/fax: 541 753 7340    : )
: )LLLLLLLLLLLLL**CHANGE THE WORLD, NURTURE A CHILD!**LLLLLLLLLLLLLLLLLL : )