I would agree with Tom - that if there is little response to decent courses
of fluconazole then the problem may be that the yeast is not Candida
albicans, but another candida (or even another fungus). (Also the problem
may be something else - as Barbara Wilson-Clay has discussed in the past).

I was going to send a post anyway as I have seen two women recently where
this happened. I don't have their files with me, but briefly they had some
response to fluconazole (10 days of 150mg/day - maybe they did this twice),
but still had some nipple/breast pain and also vaginal itching/discomfort.
The woman that I saw last week, had had a negative vaginal swab a month or
so ago, but was still complaining about vaginal symptoms and was returning
for a Pap smear, so I took more swabs (cervical this time). This time the
pathology result stated "yeast other than candida albicans" (my lab doesn't
go any further than that). I informed her about this result yesterday and
she is going to take a ten day course of ketoconazole (Nizoral) to see if
this helps.
The other woman did get a good response to ketoconazole.
Ketoconazole is not as safe as fluconazole, so I haven't liked to use it for
lactating women, but I can see there is a case for trying it, if the
diagnosis of candida is pretty definite and fluconazole has been
unsuccessful.
Lisa Amir
MBBS, MMed, IBCLC in Melbourne, Australia

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