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  • Diflucan and baby

    Diflucan is determined to be an L2 and does cross into the milk. Baby notably more problems with reflux after receiving diflucan milk. Side effect of diflucan is dyspepsia, is it possible baby's problems due to the diflucan?

  • #2
    Ertzberg:

    Its possible, as significant amounts do pass into milk (16.4% - 21.5%), although I've not heard of this side effect yet.

    Tom Hale PhD.

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    • #3
      Several of us from McClaren-Northern Michigan Hospital attended your conference at Calvin College in Grand Rapids, Mi. this week. At the end of the last session we were confused by the final slide "Do we need to continue use of Fluconazole or other topical antifungals in Breastfeeding mothers?" Why wouldn't we treat the mother if her nipples were painful, red, shiny and itchy?

      I know that there are times when painful nipples are caused by other factors, such as Reynaud's Phenomenon, where the nipples throb and turn colors, especially when exposed to cooler temperatures. But these symptoms are quite different than symptoms of yeast or mastitus.

      We were disappointed that we were left at the very end of the session without time to ask questions, especially with something as important as this. We do thank you for your excellent presentation.
      Judy Wojcik

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      • #4
        JWojcik:

        I do not think that Candida grows in the breast, or that 'shiny' nipples are infected with Candida. First, there is no good evidence of this at all. We do have a lot of evidence that it might be infectious Staph Aureus infections. In my study, I was totally unable to culture candida from these "classic" cases, nor was I able to detect evidence of candida growth with beta-1,3 Glucan.

        Thus it is my opinion, that the symptoms you are describing are caused by something else, either staph aureus, or vasospasm of the nipple or ductal tissues. Many other LCs now conclude this is some variant of vasospasm.

        You have to understand that all of the former studies where they found candida on the nipple were flawed in that they used 'dirty' nipples directly out of the mouth of infants. Remember, 80% or more of infants 3 weeks and older have culturable candida in their mouth. Thus these studies were really measuring candida derived from the saliva of their infants mouth.

        In my study, I did a clean catch, following washing with detergent and rinsing with sterile water. The "milk samples" had no culturable candida in these typical "shiny, inflame" nipples.

        So I don't know for sure what is causing these symptoms, but I no longer believe it is candida.

        As for questions, you should have come up and asked me, I was there for two hours afterward.

        Tom Hale Ph.D.

        Tom Hale Ph.d.

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        • #5
          Thank you so much for your response, Dr. Hale. I am still confused though, as to how we should be treating the symptoms if a mom presents with the itchy, burning, red nipples. Do you think Dr. Jack Newman's All-Purpose Nipple Ointment is sufficient to heal the nipples?

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          • #6
            JWojcik:

            Jack's APNO is fine, potent, and very expensive. I often suggest 1 part hydrocortisone ointment and 1 part Polysporin ointment. Mix them in your hand, and apply to the nipple. It is very cheap, you can get it without a prescription, and it seems to work. It is not at all as potent as APNO, but its worth a try. My ointment does not have any antifungal, which I don't think you need anyway.


            Tom Hale PH.D.

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            • #7
              Are you still recommending the use of Polysporin and hydrocortisone ointment for nipples with skin damage in the early days? I am hearing conflicting information about this. I have been told there is a concern about disrupting the baby's normal flora, and that hydrocortisone use can contribute to thrush. Is triple antibiotic problematic when applied to abraded nipples? The research may show that no one method is more effective than others when healing damaged nipples, but I would appreciate hearing what other hospital LC's are recommending besides fixing the latch and warm water soaks.

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              • #8
                LynnPenbay,

                One part polysporin to one part hydrocortisone cream in a thin layer on the breast is ok to use, we do not recommend triple antibiotic cream that contains neomycin.

                Sandra Lovato R.N.
                InfantRisk Center
                806-352-2519

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                • #9
                  I have been using babies magic tea to my reflux baby and got him soothed. You can try this herbal supplement whether you give it directly to your baby or drink it and pass through your breast milk.

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                  • #10
                    Fluconazole is acceptable in nursing mothers because amounts excreted into breastmilk are less than the neonatal fluconazole dosage. Although no adequate clinical studies on fluconazole inCandida mastitis have been published, a survey of members of the Academy of Breastfeeding Medicine found that fluconazole is often prescribed for nursing mothers to treat breast candidiasis, especially with recurrent or persistent infections.[2] Treatment of the mother and infant simultaneously with fluconazole is often used when other treatments fail. The most common maternal dosage regimen is 400 mg once, followed by 200 mg daily for at least 2 weeks or until pain is resolved, although a study in Australia used a dose of 150 mg every other day until breast pain resolved.[8] The dosage of fluconazole in breastmilk with these maternal dosages is not sufficient to treat oral thrush in the infant.

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