This is the newest info available as of Jan 2003 from Jack......

1. "All purpose nipple ointment"



This combination of 3 ingredients seems to help for many causes of sore
nipples, including poor latch, Candida (yeast), dermatologic conditions,
infections of the nipple with bacteria and possibly other causes as well.
It is always good, however, to try to assure the best latch possible,
because improving the latch helps with any cause of pain.



mupirocin 2% ointment (not cream):  15 grams
betamethasone 0.1% ointment (not cream): 15 grams



To which is added miconazole powder so that the final concentration is 2%
miconazole.

Sometimes it is helpful to add ibuprofen powder as well, so that the final
concentration of ibuprofen is 2%.



This combination gives a total volume of approximately 30 grams.
Clotrimazole powder to a final concentration of 2% may be substituted if
miconazole powder is unavailable, but both exist (the pharmacist may have to
order it in).  I believe clotrimazole is not as good as miconazole, but I
have no proof of that. Using powder gives a better concentration of
antifungal agent (miconazole or clotrimazole) and the concentrations of the
mupirocin and betamethasone remain higher.



The combination is applied sparingly after each feeding (except the feeding
when the mother uses gentian violet). Do not wash or wipe it off, even if
the pharmacist asks you to. In Canada, Kenacomb (easier to find) or Viaderm
KC (less expensive) ointments (not cream) can be substituted for the above
combination, but are distinctly inferior.  I used to use nystatin ointment
or miconazole cream (15 grams) as part of the mixture, and these work well,
but I believe the use of powdered miconazole (or clotrimazole powder) gives
better results.

~**~**~**~**~**~**~**~**~**~**~**~**~**
Cindy Curtis, RN, IBCLC
mailto:[log in to unmask]
http://www.breastfeedingonline.com

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