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Date: Tue, 09 Apr 1996 23:26:42 -0700
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To: Lactation Information and Discussion <[log in to unmask]>
Subject: Thrush treatments
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Dear Sandy Arnold:

You wrote about thrush treatments:

> My real question was about the various methods of treating a mom's nipples
> for thrush--just for the initial problem, not an ongoing one that has had
> treatment.  Some of our Dr's say to just put the baby's drops on the nipple.
>  Is this effective enough? Or is separate cream for the mom better?  If yes,
> why? I would think the cream would be easier to apply & feel more soothing?
>  Any other comments or personal experience?

Dear Sandy,

I'm a PA who works in private family practice.  I really LOVE being able
to write my own prescriptions --esp for BF problems!  My initial
treatment for thrush is Nysatin suspension 100,00I.U./cc.  Give 1 cc
squirted to each side of the mouth four times/day.  Try to rub it into
mucosa with clean finger or thin baby washcloth.  Use for about a week.
Refil if necessary.  Have Mom drop on her breast after each nursing and
rub around and let air dry.  (So nice to be in FAMILY practice where one
can treat BOTH the baby and the mother!)  It is sticky but usually works.
 If Mom's not happy with that then I use Nystatin cream or Lotrimin.  I
know creams won't hurt the baby but I just feel "safer" putting the same
thing on Mom's breast that I know is already FDA approved for baby's
mouth! I would say it works the 1st time about 90% of the time.

I don't know of any studies saying that cream vs. suspension is more
efficacious.  Would love to know of any.

I have suggested Gentian violet to patients but only one non-patient
(aquaintance/friend) ever took me up on it.  It didn't work for that
lady.  She found that expressing the fluid from lacto bacillus capsules
was what finally worked for her sore nipples.  (Maybe the Gentian violet
had worked onthe baby's mouth already?) But I'm not making any medical
reommendation of that one.

Sadly about half the time that I treat thrush it is for non-BF babies.

Meg Wright, PA-C
Physician Assistant