We have been finding that OTC preps such Lotrimon AF, Gyne-Lotrimon and
Monistat work better than the standard Nystatin ointment on the nipples.
If a mother is complaining of nipple pain that is consistent with yeast
symptoms, but nothing in the breast, I
recommend that she start with one of these, in conjunction with oral
nystatin for the baby, boiling of pacifiers, pumps, bras, etc, and a
change in diet. Generally speaking, if she applies a sparing amount
thoroughly so that it is pretty much rubbed in and has disappeared, it
will be absorped sufficiently by the next feeding as to be neglible in
consumption for the baby. The mistake that is most often made is the
cessation of treatment as soon as the symptoms abate; especially in the
chronic cases, treatment may need to be continued for 1-3 weeks past the
resolution time, preferably for both mother and baby. Cutting down on or
eliminating yeasty foods, milk and sugar (both sucrose and fructose, including
juices) for the duration seems to help, as does adding acidophilus supplements
and possibly Yeastguard and garlic capsules.

If she complains of shooting or burning pain in the breast as well, I am
starting to lean towards sending her to her MD for diflucan as well
sooner rather than later. Sometimes the inner pain can be alleviated without
meds, but all too often she suffers for a long time, maybe even quits, while
everyone argues over the merits of diflucan. There are two current
theories regarding dosage: a 7-10 day dose, or a one shot megadose. I do not
recall the exact amounts, but these two stategies seem to be par for the
course, and I know that I have read somewhere (Oh where could that be?) about
the efficacy of both treatments. Anybody else?  I've been rather brief,
but I hope that I have given enough to make sense. When working with
yeast, I try to cover all the bases.

Regarding the question of frequency: I don't necessarily have the answer
for you, but I do see a higher frequency when lots of antibiotics are
used prophylactically in late pregnancy and labor. Just recently I
monitored a discussion on the ob/gyn listserv, and the docs themselves
were discussing the rate of candidiasis as related to their specific
therapies. Those who are conservative and aggressively treat for any
possibility of infection (ie PROM, no apparent complications) see much
more of this problem. I don't think they are even aware of the fall-out
for nipple yeast, as so many aren't familiar with it and the mothers
themselves often don't know what is going on, either. Could the regional
differences be due to variations in regional practices with preg &
antibiotics? This may be one important factor, along with those mentioned
such as diet and weather conditions. Just a thought.

-Lisa

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Lisa A. Marasco, IBCLC                                /  [log in to unmask]
International Board Certified Lactation Consultant    /  [log in to unmask]

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