I start with local treatment consisting of:

1. Gentian violet (look under that title at the websites below). Once a day
for 4 to 7 days. If pain gone after 4 days stop gentian violet. If better
but
not gone after four days, continue for 7 days.

2. Nipple ointment as below:

mupirocin 2% ointment (10 grams)
nystatin 100,000 unit/ml ointment (10 grams)
clotrimazole 10% (vaginal cream) (10 grams)
betamethasone 0.1% ointment (10 grams)

The pharmacist mixes it all together and it is applied sparingly after each
feeding.  Do not wash or wipe it off.  You need a prescription for it.

This is used until pain free and then usage decreases over a week or so.
(See Treatments for Problems--all purpose nipple ointment).

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. If fluconazole
too expensive, ketoconazole 400 mg loading, then 200 mg twice daily for same
period of time. If Candida resistant, itraconazole, same dose and time
period as fluconazole. (See handout fluconazole).

http://www.erols.com/cindyrn/drjack0.htm

or

http://www.bflrc.com/jn_arts.htm

Jack Newman, MD, FRCPC

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