Nystatin is the traditional treatment for babies with candida
overgrown in their mouths. Unfortunately, it now has relatively poor effectiveness, due to the evolution of resistant candida. According to the experts, “Use should be limited to never-treated cases of thrush.” (Riordan & Wambach, Breastfeeding and Human Lactation
, 4th Ed.) Possible side effects include skin irritation, diarrhea, nausea or vomiting,and stomach pain.Azole creams miconazole and clotrimazole can be found labeled as athlete’s foot and jock itch remedies at the drug store (there are other drugs used for athletes foot and jock itch that aren’t necessarily safe for nursing – it’s important to read labels!). They can also be used on a mother’s nipples, and according to Jack Newman, M.D
., they don’t have to be washed or wiped off before nursing as long as they’re applied sparingly after a feeding. Possible side effects are burning, redness, skin rash, blistering or other skin irritation.
Fluconazole is a systemic drug, taken orally. Newman recommends 400mg loading dose, followed by 100 mg twice daily until mother is pain-free for a full week, and this regimen can be really effective, especially when other treatments haven’t worked. This can be used along with topical treatments, and has been used in newborns and premature infants in the hospital, though I’m not sure if pediatricians will prescribe it generally. It has little transfer into mother’s milk. Possible side effects include acid or sour stomach, belching, change in taste or bad, unusual, or unpleasant (after) taste, heartburn, indigestion, stomach discomfort or upset.
All Purpose Nipple Ointment is an invention of Jack Newman’s. It combines antifungal, antibiotic, and corticosteroid drugs into one cream, to kill yeast and opportunistic bacteria while reducing inflammation (and thus pain). It needs to be prepared by a compounding pharmacy, and it can’t be used in a baby’s mouth, but it can be well worth the effort for a suffering mom. The formula is Mupirocin 2% ointment (15 grams) + Betamethasone 0.1% ointment (15 grams) + Miconazole powder to make final concentration 2%. There have been no clinical trials for efficacy or toxicity, and under some circumstances, corticosteroid element may favor yeast growth.
Next time: Alternative treatments for candidiasis
(What the heck is up with the formatting? This is what I get for being a slacker and cutting and pasting a bunch of my content. I will wrestle with the HTML when I have time. In the meanwhile, I apologize for the slightly odd text.)