Currently treating a 39 yo mother of four children -fourth born 10 years after the last. She came at 5 weeks with severe breast pain during and after the nursing -burning and stabbing. Going over the first 5 weeks she had already had sore nipples from the beginning, at least one bout of mastitis treated with inadequate antibiotics (amoxicillin) and then with cephalexin that she was taking for an infected toe. On physical exam she had plugged ducts at 3 and 6 oclock on both breasts. Baby latched on well and held with good position. It sounded like a classical yeast infection so I gave fluconazole as well as soaks and massage to the plugged areas. After two days she felt much better. She then developed the beginning of mastitis in one breast (local redness and pain over one of the areas that had been plugged)- treated again with dicloxacillin. (she was still on the fluconazole) By the next day she was back to pain in both breasts, burning and getting worse. I have suggested a higher dose of the fluconazole boiling all artificial nipples (I first suggested not using these but haven't succeeded there). She is crying and about to give up on the nursing. All advice gratefully accepted. Could this be something other than yeast? If so what and what can be done to help reduce the pain? TIA Deena