Hello all,
Apparently there will be more mupirocin ointment (bactroban) available in
August. In the meantime, a compounding pharmacy could probably get
mupirocin powder and mix it in with the other things. Creams separate from
ointments, especially in summer. Better to use all ointments. In fact,
seeing what happens to some of these mixtures, I would take polysporin
ointment and use it instead.
Here is the "new candida protocol as I now use it". The APNO is two.
Candida Protocol
Start with local treatment (applied on the nipple) with:
1. Gentian violet (look under that title at the websites below). Once a day
for 4 to 7 days. If pain is gone after 4 days, stop gentian violet. If
better, but not gone after four days, continue for 7 days. Stop after 7 days
no matter what. If not better at all at 4 days, stop the gentian violet,
continue with the ointment as below and call.
Plus:
2. Nipple ointment as below:
mupirocin 2% ointment (15 grams)
betamethasone 0.1% ointment (15 grams)
To which is added miconazole powder so that the final concentration is 2%
miconazole. This combination gives a total volume of approximately 30
grams. Clotrimazole powder to a final concentration of 2% may be
substituted if miconazole powder is unavailable, but both exist (the
pharmacist may have to order it in). Using powder gives a better
concentration of antifungal agent (miconazole or clotrimazole) and the
concentrations of the mupirocin and betamethasone remain higher.
The combination is applied sparingly after each feeding (except the feeding
when the mother uses gentian violet). Do not wash or wipe it off, even if
the pharmacist asks you to. In Canada, Kenacomb (easier to find) or Viaderm
KC (less expensive) ointment can be substituted for the above combination,
but are distinctly inferior. I used to use nystatin ointment or miconazole
cream (15 grams) as part of the mixture, and these work well, but I believe
the use of powdered miconazole (or clotrimazole) gives better results.
These ointments can be used for any cause of nipple soreness ("all purpose
nipple ointments"), not just for Candida (yeast). The ointment is used
until pain free and then decrease frequency over a week or two until
stopped. (See Treatments for Problems 1 under "all purpose nipple ointment"
at the website below).
3. If pain continues and it is sure the problem is Candida, or at least
reasonably sure, add fluconazole 400 mg loading, then 100 mg twice daily for
at least 2 weeks, until the mother is pain free for a week. The nipple
ointment should be continued and the gentian violet can be repeated. If
fluconazole too expensive, ketoconazole 400 mg loading, then 200 mg twice
daily for same period of time (or grapefruit seed extract can be used). If
Candida resistant, itraconazole, same dose and time period as fluconazole,
though Candida actually is less sensitive to itraconazole, generally, than
it is to fluconazole. (See handout Fluconazole). Fluconazole is apparently
now available as a generic product (therefore less expensive). Fluconazole
should not be used as a first line treatment or if nystatin alone does not
work (which it usually doesn't).
4. Grapefruit seed extract (not grape seed extract), 250 mg three times a
day orally (taken by the mother), seems to work well in many cases. It can
be used instead of fluconazole or in addition to fluconazole in resistant
cases. See over for information on grapefruit seed extract.
5. For deep breast pain, ibuprofen 400 mg every four hours may be used until
definitive treatment is working (maximum daily dose is 2400 mg/day).
http://www.breastfeedingonline.com
Jack Newman, MD, FRCPC
Revised: June 14, 2002
Grapefruit Seed Extract
Grapefruit seed extract can be used while using the all purpose nipple
ointment. Apply the diluted liquid grapefruit seed extract (see Dr. Jay
Gordon's website, at the bottom of the page for more information) on the
nipples, then the ointment (both after the feeding).
Here is the site of the company recommended by Dr Jay Gordon:
http://www.nutriteam.com/gse.htm
It has a lot of information about GSE...here is their dosing info:
Recommended Dosage for NutriBiotic Liquid Concentrate:
These recommendations are for NutriBiotic Original GSE.
Those using Citricidal Professional Strength liquid concentrate should
divide these recommended dosages by three(or multiply by 1/3).
Internal Use
Note: Never use full strength, may cause irritation.
Orally. Suggested Use: 5 to 15 drops mixed in 5 ounces of water or juice, 2
to 5 times daily, with or without meals. (Or, take one-two NutriBiotic
CapsulesPlus® or one-two NutriBiotic® tablets (125 mg each) 1 to 5 times
daily). Children(under 10 years): 1 to 6 drops mixed in 5 ounces juice, 2 to
3 times daily. Do not use full strength in mouth.
Some people think the liquid extract is more effective. And Dr Gordon only
uses it topically, as he describes on his website:
http://www.drjaygordon.com/bf/thrush.htm
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----- Original Message -----
From: "Alice Ernest" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, August 16, 2002 12:23 PM
Subject: Re: APNO
> Help. Need the "recipe" ASAP. Can't put my fingers on it. Search of
> archives unhelpful. TIA
>
> Alice Ernest IBCLC
> Simpsonville, SC
>
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