I recently sent milk cultures in on a woman with persistant pain despite tx with diflucan from her Midwife. Lab showed very small amounts of "normal flora" and refused to identify organisms and run a sensitivity due to nothing abnormal in sample.
Since, as Dr Anne Eglash mentioned, fluconazole can suppress coag negative staph, perhaps we need to refrain from sending milk cultures in women who've been on fluconazole for a time -- maybe wait a week or two?  Would anyone else treat empirically? I started her on Clinda, as she is a military wife and about to move across country. A week later she'd had no improvement, but admitted that she hadn't taken the abx routinely.
Melinda Harris-Moulton, FNP-BC, IBCLC

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