I have read all the archives posts regarding resistant thrush, but still am hopeful to find additional information I might use to help a mother I'm working with. I have her permission to post.  I saw her initially when the baby was 3 weeks old.  She complained of nipple pain, including itchiness on the nipples. She said she had been using gel pads and lansinoh to treat her nipple pain.   There was no evidence of yeast in the baby (either in the mouth or diaper area).  After tweaking baby's position at latch, which was basically sound, we discussed likely thrush, and I counseled her about dietary changes (reducing simple sugars, white flour, fruit juices, eliminating alcohol, and taking a high-quality probiotic blend, etc.) and suggested she try the Grapefruit seed extract both orally and topically as on Dr. Newman's protocol for yeast.  I also explained the necessity of treating baby simultaneously even if baby was asymptomatic.  The baby's pediatrician prescribed oral nystatin for baby, and mom began applying it to baby's mouth while she was using the GSE.  She also began taking oral diflucan for herself , taking a loading dose on day one, and then continuing on with 200 mg. twice a day. After two days, she called back and said she now had pain that radiated back into her breast.  I encouraged her to continue the diflucan.  After 5 days on diflucan (baby is still on nystatin at this point), she calls and says it is really no better, and she asks if she can do gentian violet at the same time.  I say yes she can. The baby began oral diflucan on mother's 6th day of diflucan treatment.   Now, this morning she called and says she has now taken 10 days of the diflucan and done GV for 5 days, and she still has burning pain, no longer on the nipple surface but deep into the chest which comes and goes. She reports the nipples are still very cracked and tender.   She says the pain is worse at night, and is making it very difficult for her to sleep.  (She takes ibuprofen for the pain).  Today she says she is contemplating weaning because of the pain and sleep disturbance. This is a lovely, dedicated first-time momma - I hate to see her quit.  If anyone could please offer treatment suggestions at this point, I would be very grateful. 
-Aimee, IBCLC in Virginia

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