Fluconazole

by Jack Newman, MD, FRCPC

Here's What You'll Find Below:Candida (yeast) infections of the nipple and ducts
Diagnosis of Candida infections
Typical symptoms of a Candida infection
Treatment

Fluconazole (Diflucan™) is a synthetic antifungal agent that can be used for the treatment of Candida albicans and other fungal infections. For the breastfeeding mother in particular, it can be used after other first interventions to treat recurrent Candida infections of the nipples, and, if such a thing exists, as I believe it does, Candida infections of the breasts. If a mother has sore nipples, the nipples must be treated aggressively first and then is fluconazole (Diflucan) added if nipple treatment alone is unsuccessful.

Candida (yeast) infections of the nipple and ducts

Candida infections of the nipples may occur any time while the mother is breastfeeding. Candida albicans likes warm, moist, dark areas. It normally lives on our skin and other areas, and 90% of babies are colonized by it within a few hours of birth. It, like many other germs that live on us normally, only becomes a problem under certain circumstances.

Candida infections of the skin or mucous membranes are more likely to occur when there is a breakdown in the integrity of the skin or mucous membrane—one of the reasons why a good latch is very important from the very first day. Many Candida infections would, perhaps, not have occurred if the mother had not had sore nipples and a breakdown of the skin of the nipples and areola. The oozing of liquid that occurs often from cracked nipples encourages Candida albicans to change from its harmless form to an invasive form.

The widespread use of antibiotics also encourages the overgrowth of Candida albicans. Many pregnant women, women in labour, and new mothers, as well as their babies receive antibiotics, sometimes with very little justification.

Diagnosis of Candida infections of the nipples and/or ducts

There is no good test which helps makes the diagnosis. A positive culture from the nipple(s) does not prove your pain is due to Candida. Neither does a negative culture mean your pain is not due to Candida. The best way to make a diagnosis is by getting a good history.

Diagnosing the presence or absence of a Candida infection in the baby is not helpful. A baby may have thrush all over his mouth, but the mother may have no pain. A mother may have the classic symptoms of a Candida infection of the nipples, and the baby may have no thrush or diaper rash.

The Typical Symptoms of a Candida Infection of The Nipples Are

• Nipple pain that begins after a period of pain-free nursing. Though there are a few other causes of nipple pain that begin later, Candida infection is definitely the most common. The nipple pain of Candida may begin without an interval of pain-free nursing, however.
• Burning nipple pain that continues throughout the feeding, sometimes continuing after the feeding is over, sometimes beginning in the middle of a feeding as baby is still drinking well.
• Pain in the breast that is “shooting” or “burning” in nature and which goes through to the mother's back and shoulder. This pain is usually worse toward the end of the feeding, and worsens still more after the feeding is over. It also tends to be much worse at night. This pain may occur without any nipple pain.

Treating Candida Infections of the Nipples

Our first approach to treating these infections is to apply the All Purpose Nipple Ointment (APNO) (see information sheet APNO). Next, the mother can add topical Grapefruit Seed Extract and/or Gentian Violet (information sheets Gentian Violet and Candida Protocol) if the ointment alone does not work. This approach is safe, works rapidly, and almost always, though there seems to have been a decrease in the effectiveness of gentian violet over the past few years.