Hello friends-I haven't "seen" much of you in a while-too busy helping women
breastfeed, I guess :)   I need some help from the net folks with a resistant
candidiasis case.  This mom is mother of very premature twins born in Sept.
at 29 weeks.  The boy is now home, doing well, and nursing well.  The girl,
who was very much smaller, is just now being transferred from Level III to
Level II center to finish growing.  Mom, who is an RN and neonatal nurse,
began pumping right after delivery, and kept it up until the boy came to our
hospital in November.  Mom developed sx of candidiasis of nipples and ducts
somewhere around that time.  She treated with topical nystatin and
clotrimazole, and it seemed to help initially, but despite long term therapy,
she keeps having recurrences.  The little boy eventually developed thrush and
a candida type diaper rash, so both were treated with
nystatin/mycostatin/mycolog with no resolution.  Next we tried oral
fluconazole, first a course of 200mg. loading dose for Mom, then 100mg/day x
14 days, and 3mg/kg dose for baby.  After 8 days of no results EXCEPT that
his diaper rash cleared rapidly, we went to 200mg./day every day for mom, and
6mg./kg. dose for baby.  After 8 days at THAT dose, baby still has quite a
furry posterior tongue (tho no diaper rash), and mom feels absolutely no
better.  Still with nipple involvement/pain, and much ductal pain.  She is
not diabetic, but prior to delivery states that it was not unusual for her to
have vaginal candidiasis 2-3x/yr.  She is very well informed, and willing to
try most anything.  We are having milk cultures done, and also cultures of
baby's mouth, to rule out the possibility that this is NOT candida. Don't
believe that this is a dermatitis.  She is trying a diet modification,
eliminating starches and sugars as much as she can.  I have considered
gentian violet painting of her nipple/areola and baby's mouth x 1 or 2.  I
know toxicity concerns, and would not use more than 3 days.  Does ANYBODY
have suggestions for this?  I have discussed with some MDs here, but they
have limited experience with this also.  We don't want to have to consider
Amphotericin.  What are our other choices? Thanks in advance for your help.
 If this has been discussed in depth on the net recently, and I have not
seen, if someone would just tell me which digest to pull up, I'd be grateful!

Denise Mollenkopf, RNC, FACCE, IBCLC
Florida
[log in to unmask]