lisa,

Had a very long discussion about this  with Dr Jack newman from toronto when
he spoke at our MALC confernece on May 20th in windsor ont canada.

Pump and dump from a single 150mg dose (that is the one bullet cure for
vaginal infections - not ductal yeast), seems a bit extreme (when they give
it directly to nicu babies, in much higher doses than the baby would likely
recieve via the milk, with miminal side effects in already compromised
infants,)

We are talking about a older otherwise healthy infant aren't we?  Dr Newman
has been using nizoral (ketokonozole) tablets in his breastfeeding clinics (1
tab qd for up to 3 weeks), it available cheaper (its in the canadian drug
formualry) even though it does have a greater liver side effect profile for
the MOM than diflucan does. He did state that if diflucan were part of the
formulary, he would probably use it. In almost all his thrush-yeast cases mom
gets a oral med also.  He feels this puts and end to the treat - retreat -
reatreat cycle so many moms have to suffer through.

Locally (USA  SE lower Michigan) We have been using diflucan in the following
doses with much success (100mg daily for 13 days <13 tablets total>, mom
doesnt have to remember much) or (200mg day one, 100 mg days 2 - 6 and 50mg
days 7-12 <10 tablets total>.  The doctors here usually under treat just the
baby with nystatin first & foreget that mom is in the picture at all. Then I
come into the picture when mom is really ready to quit because she is so sore
(no one believes that just treating the baby isn't enough)  It can't be yeast
baby has no spots.

I had a mom that had had deep breast pain during and after feeding for over 6
months before a very wise LLL & consultant referred her to me. mind you
neither her or the baby had any outward signs of a current yeast infection.
 Baby did have a mild thrush infection at about 3 weeks of age.  Mom was
treated with the 200mg loading dose 10 day therapy (to rule out yeast as a
possible cause)  she was told if by the 4th day she was not starting to get
relief to stop the med.  by the end of day 3 the shooting pains had started
to level off by day 7 she only had 1-2 pain attacks per day by the end of
treatment she was totally pain free, and still is pain free and nursing to
this day.

Generally I have found if it is yeast, moms start getting some relief between
72 & 48 hours.  Dr Newman states that in severe cases it may take up to 5-7
days.  In his words if moms have recurrent mastitis, repeated plugged ducts,
deep breast pain, suspect yeast as a contributing factor and treat mom orally
as well as the baby.

Sorry I ran so long,

Anne F. Norton-Krawciw, RPh, IBCLC ("the" pharmacist)
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