Should I apply the gel anyway, or continue to give the syrup which doesn't seem to work that well?
31-year-old woman
Hello! I am traveling and had started treating our baby and me for thrush before I got here. There was not much improvement in 10 days so I went to the hospital (in Greece) to get an oral treatment for me as I suspect I have it inside my breast. The pediatrician here prescribed me a gel (miconazole 2%) to put in my 2 1/2 month old baby's mouth, 3x a day, and an oral treatment for me, 7 tablets 1 a day (fluconazole). But when I read about the gel on the internet, it says not to give this medicine before at least 4 months, even 5-6 months since the swallowing reflex is not yet completely acquired and there is a risk of choking. What do you think? My daughter is exclusively breastfed and chokes on my milk because of my strong gag reflex. In Quebec I was prescribed a syrup for my daughter and I still have some left.
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Nathalie Gagnon · 3 years ago
Hello,
Fluconazole is usually very effective, but often prescribed at too low a dose and for not long enough. See page 21: https://www.ciusss-capitalenationale.gouv.qc.ca/sites/default/files/guide_pratique_allaitement_medecin.pdf
On page 20, it talks about symptoms; is that what you are experiencing?
What were you using for yourself? For your baby, it was nystatin?
Miconazole or clotrimazole gels or lozenges do not exist in Canada, but are reported in the literature.
When are you coming back to Canada?
And you talk about your strong ejection reflex.... What tricks do you use to minimize choking?
31-year-old woman · 3 years ago
Thank you for your response! So me I was putting canesten on my nipples, 2x/day, nystatin for my baby 4x/d. The symptoms I have are inconsistent nipple irritation with nothing physically apparent, but mostly pain "behind" the nipple, inside my breast, sometimes radiating upwards, but very randomly. My ejection reflex is also more and more uncomfortable, especially on the left side, it stings a lot when the reflex is triggered. The doctor here has prescribed me fluconazole 200mg for 7 days. I see that this differs from the document you shared with me. My spouse is also doing the treatment, per the doctor's request, so he also has 7 pills to take. Should I split my tablets in 2 to have 100mg per day and be able to continue them for 14 days as mentioned in the document? My spouse may not need his tablets and I could also take them to get a 400mg tomorrow (I took my first 200mg tablet today). Or try to get more tablets for myself and my spouse. I'm coming back to Canada in 1 month so I hope to have this sorted out before then!
For my REF I sponge the milk with a debarbaby when it comes out too strong, my daughter has also learned to withdraw from the breast, and I breastfeed lying on my side or in a physiological position so the milk flows slower.
Nathalie Gagnon · 3 years ago
Perfect for managing FEB: we use a position where baby's head is higher than the breast.
Why is your spouse being treated...?
100 mg twice a day or 200 mg once a day would be acceptable; so it's the duration that I'm concerned about. As you read, it should be continued for at least 14 days or an additional 7 days after symptoms have resolved.
As for the frequency of the canesten for you, as you can also see in the handout, it should have been applied after each feeding in a thin layer. For the nystatin syrup, you can do the same for baby, which is after every feeding.
Everything that comes in contact with baby's mouth should be disinfected.
31-year-old woman · 3 years ago
The doctor here was saying if I have thrush maybe daddy has it too so he wanted to treat both of us. We're dropping the pills for him and I'm taking them for myself so I can have them for 14d? And I'm continuing with nystatin for my baby for now after every feeding and canesten on my nipples after every feeding. When I run out of syrup is it ok to continue with the gel even though my baby is under 4 months old?
Nathalie Gagnon · 3 years ago
Treating the spouse is definitely not common practice here.
Have you started the gel? It should be applied in a thin layer.
Yes, you might decide to continue thinly coating your nipples and areolas with canesten.
31-year-old woman · 3 years ago
I haven't started the gel yet, I was thinking I might follow up with it when the syrup is done. What do you think? Is it ok if my daughter is not yet 4 months old as it says on the product?
Nathalie Gagnon · 3 years ago
Some health professionals recommend Canesten cream directly in the baby's mouth because the gel is not marketed in Canada. In addition, in pregnancy, lactation and pediatrics, it is often off-label and recommended from product monographs. Finally, there is less resistance to clotrimazole/miconazole than to nystatin. Hopefully, this will guide you in your decision-making process.
31-year-old woman · 3 years ago
Thank you very much!
Nathalie Gagnon · 3 years ago
Hoping it all helps, I wish you a beautiful night.
31-year-old woman · 3 years ago
Yes very helpful 😊
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