Hi everyone.  I am struggling with a mom of 2 week old twins.
She came to me with shooting pains in her back and shoulders,
burning/stinging between feedings, and tearfulness while nursing.
Seemed like a no-brainer.  She also has battled yeast for years, had at
one point been on 200mg fluconazole daily for 6 months ( yes, months!)
Anyway, c-sx, got abx, probably got yeast.  I have prescriptive
privileges and got info. together to discuss with her ob about treating
he for ductal candidiasis - he had never heard of using diflucan in a
400mg X 1 then 200 mg for up to 4 weeks dose as is suggested in Hale but
agreed to "agree" if I would prescribe it.  So I did.  And oral nystatin
for the babies.  And all purpose nipple ointment (mycolog/bactroban) for
mom's nipples.  Things got slightly better for about a week - now are
horrendous and she has a vaginal yeast infection, and signs of ductal
candidiasis. She went to her ob/gyn today who said she'd never heard of
anyone being "resistant" to diflucan, and that if diflucan wasn't making
her breast pain go away, then it wasn't yeast.  And then went on to give
a vaginal yeast cream (?Terconazole?)  I'm not sure what to do next.
What would you do?  thanks....janna zempsky, cpnp, ibclc in w. hartford,
ct.

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