Dear Aime, 
While I am not a diagnostician, if it is yeast, that dose is not high enough for Mom. A real systemic yeast infection, especially one as long-playing as that one, should probably be treated with a much higher dose for a few weeks (perhaps 400mg a day, but it's up to the prescriber), since they probably made it resistant by using a 150mg dose. The 150mg dose is meant to be a one-time dose for s simple vaginal yeast infection.
I would suggest that she see an infectious disease specialist to get this worked out once and for all, the right way! She may need an entirely new drug by now.
Be well, 
Laura Block, PharmD, CLC

****

Date:    Wed, 23 Jan 2008 13:39:23 -0500
From:    Jamie Huddleston <[log in to unmask]>
Subject: thrush? need help quickly!!

Hi All,

I am working with a client, permission to post, who has battled thrush fo=
r the=20
past 3 months.  She has been told to stop nursing by her doctor and doesn=
't=20
want to.  I have to wonder if she has something other than thrush, as all=
 the=20
tricks I know and have suggested have not worked.  I am hoping you all ha=
ve=20
some other insight that I can share with this mother.

Here are the details:
Baby was first diagnosed in November (at 1 month of age) with oral thrush=
 by=20
babies pediatrician, baby was given Nystatin.  Mom's doctor gave her Nyst=
atin=20
cream for nipples.  At that time, Mom had sore nipples but no thrush rash=
.=20=20=20
No relief of symptoms for 6 or 7 weeks with use of Nystatin for Mom and b=
aby,=20
had refilled prescription and continued to use this entire time.=20=20=20=


In December, Mom saw babies doctor again, and baby was given diflucan and=
=20
Mom was told to stop nursing.  Mom also contacted her ob-gyn at the time=20=

and her doctor didn't want to prescribe diflucan for her.=20=20

This is when I was brought in.  Mom called me, didn't want to stop=20
breastfeeding and wondered what to do to treat the thrush.  I discussed=20=

simultaneous treatment.  Mom called her doctor back and after trying a=20=

different Nystatin cream, was able to get a prescription for Diflucan=20
(150mg/day 1 time a week for 2 weeks) from another doctor in the practice=
.=20=20
Babies doctor also gave a prescription for Gentian Violet in December, ba=
bies=20
symptoms have improved significantly with this.=20=20

Mom then visited her doctor in January (diagnosis for Mom had been over t=
he=20
phone because she has no insurance and can't pay for the doctor's visits)=
 and=20
was confirmed that Mom had thrush.  Her dose of diflucan at this time was=
=20
increased to 150mg/day for 7 days.  No improvement of symptoms, so=20
prescription changed to 100mg/day for 14 days.  No improvement again.  Ra=
sh=20
would worsen, then improve next day, then worsen- continued like this for=
 the=20
course of treatment.=20=20

Now, doctor will not see Mother or prescribe any more meds until mom stop=
s=20
breastfeeding.  She does not have a primary care physician, so has been=20=

seeing her ob-gyn.  She does not want to stop nursing, but continues to b=
e in=20
a lot of pain.  Rash has worsened since diflucan treatment has stopped.

Some more pertinent details:
Rash on Mom is red, scattered, patchy bumps.  Look like water filled sacs=
,=20
pustule, that are the size of a pin head.  Nipples are raw, open and visi=
ble=20
bumps when baby comes off breast after a feeding.  Between feeding, rash =
is=20
dry and sore.  Rash is around and on nipples, areola, under and on sides =
of=20
breast.  Not on the top of breast.

Pain at nursing is described as "someone's fingers under my skin", very i=
tchy=20
and sucking feels like something is pulling and itching through the milk =
duct.=20=20
Mom can feel the pain from the base of her breast and work it's way to th=
e tip=20
of her nipple with baby nursing.

Mom has a vaginal yeast infection as well, which she has had since June/J=
uly.=20=20
She is treating this with topical cream, over the counter.  Has not helpe=
d mom=20
at all.  She was also diagnosed as a child with "allergy to yeast".  She =
admits=20
being a heavy alcohol user in college, with no yeast problems during this=
 time

Mom is washing all clothes in vinegar. Has changed diet also- cut down on=
=20
sugary foods, eats more whole grain, increased yogurt (eats 6lbs per week=
),=20
more green vegetables, cut down on fatty foods.  Mom and Dad are also=20
taking acidophilus capsules daily.  Dad shows no symptoms of thrush but h=
as=20
been taking the acidophilus and following the other dietary changes.

Mom has started to introduce formula, but baby doesn't like it and doesn'=
t=20
want it.  Mom continues to breastfeed as long as she can tolerate the pai=
n.=20=20
She is also pumping 4-6 times a day, and offering her milk in a bottle.

I hope you all can help.  If you need additional information, please cont=
act me.

Jamie Huddleston, IBCLC
York County WIC Program
Sanford, Maine


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