Since Candida is back on Lactnet, I just thought I would post the latest
concotion I use for Candidal infections of the nipples.  It seems to work
quite well. It is similar to what is on the Treatments for Problems sheet,
but, I think, it is improved.  It can be used alone, or better yet, with
gentian violet.

mupirocin 2% ointment (5 grams)
nystatin 100,000 units/ml ointment (5 grams)
clotrimazole 10% (this is the vaginal cream) (5 grams)
betamethasone 0.1% ointment (5 grams)

The pharmacist mixes it all up and the mother applies it sparingly after
each feeding and does *not* wash it off or wipe it off.  If the mother also
uses the gentian violet, the gentian violet is used once daily (as described
in the handout Gentian Violet on the websites below) instead of the
concotion, but the concotion is used after all the other feedings.  If you
want a rationale for the above, you can find it in the handout Treatments
for Problems at the websites below.  The concotion can also be used as a
"good for all things don't know why it works nipple ointment" or "all
purpose nipple ointment".  If that's what it's used for, you could probably
leave out the nystatin.

I also think that gentian violet can be used longer than three days, which
seems to have gotten into the mythology.  I suggest the mother do the
following after 3 or 4 days:

1. Pain is gone.  Terrific.  Stop gentian violet, wean from concotion over a
week.
2. Pain better, but not gone.  Continue gentian violet and concotion for
another few days, say for a week.  If pain gone, return to 1.  If pain not
gone, but continuing to improve (as it almost always does with this
scenario), continue concotion and when pain gone, wean from concotion over a
few days to a week.
3. Pain not changed or, groan, worse.  Stop gentian violet, continue
concotion.  Phone me.

What do I do when the mother phones?  Depends.  This is uncommon,
incidentally.

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

or

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

Jack Newman, MD, FRCPC