I have a young mom who has moderately severe asthma on inhaled steroids,
serevent and proventil.  For her ductal thrush, she is on Diflucan and
acidophylus.  Because I helped her relactate she is also on Reglan, fenugreek
and blessed thistle.  She presented to me having quit nursing for 24 hours
due to the pain from the ductal thrush and developed bilateral mastitis.  She
responded well to therapy and relactation (she has extra milk), however she
stopped her Diflucan (after 3 weeks at 200 mg) and within a week it
redeveloped and it is really painful.  She can't recall if she was off a
whole week before she stopped but it was certainly several days.  Newborn
baby was treated for symptomatic thrush.  I will check mom's liver enzymes
next week.  I am concerned that because of the inhaled steroid that mom might
need long term treatment with the Diflucan and/or that she may develop
resistance.  Has anyone dealt with a similar patient?  Has anyone given
Diflucan say maybe 3 times a week long term?  How long should she be symptom
free, this time before I stop treatment?  10 days?  If she develops
resistance is there another med I can use?   If  "accolate" is used could it
potentially decrease her steroid use?  This mom is a real trooper.  I amazed
that she hung in there.  It is rare that I have seen that much pain.
Christine Betzold MSN RNP CLE

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