However, most of the mothers I see with suspected yeast end up on oral Diflucan. This is interesting to hear as I have only been game enough to treat mothers with oral nystatin. I know that it doesn't appear in breastmilk, and the reason it works seems to be related to reducing the overall colonisation of the mother's body by thrush, rather than a direct effect on the breast. I also use a topical treatment for both nipples and baby's mouth (usually miconazole gel), plus treatment of nappy (diaper) rash and vaginal thrush if indicated. I have thought of using oral fluconazole, but have been put off by the fact that it appears in breastmilk at concentrations similar to blood levels, and can cause abnormalities in liver function tests. The manufacturers do not recommend its use in lactating women. In Australia it can only be prescribed either as a once-only dose of 150mg for recurrent vaginal candidiasis, or as a longer treatment for life threatening fungal diseases. The cost of any more than the once-only treatment is extreme (more than A$200 I think). Ketoconazole tablets can also cause liver enzyme problems, and again, I'm not sure about using this. I've never considered oral Terbinafine, as it is only active against candida in the ointment rather than tablet form, according to the information from the pharmaceutical company. I'd be really interested to hear about other drug treatment for thrush, as experience in my part of the world seems limited. What has worked for you? How safe was it?