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Fluconazole sort of working but is it candida??

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  • Fluconazole sort of working but is it candida??

    Hi Dr Hale/colleagues/posters

    I am hoping you can help me with a clnical question because I have seen 3 GP doctors and an obstetrician and I am getting nowhere.
    I am in Australia so I am hoping I can find an answer on the forum instead of by phone.

    I am currently breastfeeding my 11 week old baby. I breastfed without problems for 5 weeks (no nipple trauma, no latch issues, etc).
    Since week 5, I have had a recurrent bleb/blocked duct which I had to open aggressively at each feed.
    I since developed what the lactation consultant thinks are thrush symptoms.
    From week 6, a white spot appeared at the tip of the nipple, and appeared to be deep embedded in the nipple (not able to be wiped off, not sore to touch).
    From week 7, I developed deep random stabbing pains in both breasts, but mostly in the area with the blocked duct. This progressed rapidly to severe stabbing pains, especially after feeding. I also had extreme sensitivity of breasts and nipples even just to lightly brush the outside.
    I started to take fluconazole 150mg every 2 days (took 5 doses). The pain reduced dramatically within a few hours but returned before every dose. After 5 doses the outer breast sensitivity even returned.
    Then I started 200mg fluconazole daily (100mg twice a day) for a week - again the pain returned before every dose. So I tried 200mg once daily for one day but the pain was more severe.
    The white spot on the top of the nipple now has three tiny red blood-coloured spots next to it.
    I have had an ultrasound of the original blocked duct area which was blocked on and off for a few weeks, and the results are normal.

    My question is: I am aware Dr Hale has done research which showed that staphylococcus aureus, not candida, may be responsible for these type of symptoms. But as the fluconazole was working, would this be candida after all? But if it is, why can't I get rid of it fully with the fluconazole? I have been following other guidelines like miconazole on nipples and baby's mouth, boiling pacifiers, etc.

    I am afraid that the candida may be getting resistant to the fluconazole. I am also afraid of taking the fluconazole for much longer as it has already been 3 weeks, and the higher dose didn't help much. I read somewhere that the antibiotic treatment for staph is >4 weeks, and that cultures that reveal the presence of staph and/or candida don't necessarily mean that they are causing the pain?? I am wary of taking antibiotics if it is a fungal problem and will make the infection worse. i would love to breastfeed my baby for at least year but I am worried that I have been giving him drug-laced breast milk for most of the weeks we have been breastfeeding.

    Where can I go from here? I would much appreciate any help. If a milk culture is required, please let me know exactly what needs to be written to pathology as my doctor is not aware of such a thing. If antibiotics are required, can they be taken at the same time as the fluconazole?
    Last edited by ftm; 07-31-2017, 04:58 AM.
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