>I agree that the dose mentioned for nystatin is not frequent enough and
for fluconazole is not strong enough. (Hale says 200-400 mg.for loading
dose and 100-200 mg daily for 14-21 days after.)  By treating thrush in a
mild/ineffective  fashion I think we are making thrush  resistent.  Of
course try the gentian violet first.  It is easily available, cheap and
effective ! <

Can I just point out that the dosages mentioned came from our Breastfeeding
Network leaflet which is for use in the UNITED KINGDOM.  We looked at
literature for the dosages we suggested and know of some in the UK who are
using higher dosages.  My co-author (a pharmacist as well as a Breastfeeding
Supporter) and I constantly review what we are doing.  We are aware of
concerns of resistence, but the situation in our population may differ in
some ways.  When we wrote the leaflet we knew we were doing something a bit
controversial, but I cannot describe the amount of hassle, flack and
vituperation we have taken on the chin for the past three years over this.
If we had suggested a higher dose of Fluconazole or dared raise the issue of
gentian violet at the same time (we were the first to publish in the UK
about use of fluconazole and involved in the first wave of publicity about
thrush in breast feeding) both of us might now be recovering in a
sanitarium!!  We are still having people come up to us at conferences saying
how violently they disagree with us for being so radical.  There have
certainly been times when I have bitterly regreted even thinking of doing a
leaflet on the subject at all.

Magda Sachs
Breastfeeding Supporter, BfN, UK

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