Expert Q&A

	By Mary Kay Smith IBCLC, Lactation Consultant

How is thrush diagnosed and treated?

Work with your medical provider to diagnose and treat thrush. Keep in mind that some physicians are skeptical of the theory of breast and nipple yeast and may need some more information before treating it.

Diagnosis of breast yeast by milk culture is not always reliable, as yeast is always present on the skin or in the milk in small amounts. The fact that lysozmes in human milk may destroy yeast organisms can further complicate the interpretation of milk cultures. There is research available which states that the presence of yeast in a urine culture can indicate that yeast overgrowth is present.

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.

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.

There are strains of Nystatin-resistant yeast which 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 enters the milk and what does reach the baby is destroyed in the gastrointestinal tract.

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