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The Sore Truth
Thrush Diagnosis and Treatment
By Mary Kay Smith, IBCLC
Treatment options should be based on the severity of pain in the mother and baby and involvement of other parts of the body. First line treatment measures usually include a topical antifungal to Mother's nipples and Baby's diaper area along with simultaneous treatment of the baby's mouth with oral liquid antifungal medications, such as Nystatin.
Topical medications that can be applied to the nipple skin and diaper area such as Mycostatin cream and Lotrimin are now available over the counter. Others such as Nizoral (ketaconazole cream) or Lotrisone (clotrimazole betamethasone cream) may be available by prescription only.
Occasionally, mothers are advised to treat the nipple with the baby's oral medication, but its high sucrose content may encourage rather than discourage yeast growth. Regular applications of medication are important, as yeast replicates quickly (in less than three hours). Both mother and baby should be treated after each feeding, as this is when the transfer of the yeast organism takes place.
There are strains of Nystatin-resistant yeast that require more "intensive" measures, including an oral antifungal medication. Diflucan (fluconazole) is one that is currently used in a single application dosage to treat vaginal yeast infections. To be effective against ductal yeast or systemic yeast, a dosage of at least 100 milligrams per day for 14 days is necessary. Most practitioners also use a loading dose (first dose) of 200 milligrams.
Some physicians feel that this medication should be contraindicated in breastfeeding women. However, new research shows that very little entrs the milk and what does reach the baby is destroyed in the gastrointestinal tract.
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