Thrush in the Breastfeeding Dyad: Results of a Survey on Diagnosis and Treatment

Abstract

Infection with Candida albicans in the breastfeeding dyad has been associated with extreme pain in the breastfeeding mother and may lead to premature weaning. There is presently a dearth of information on diagnosis, natural history, and treatment of this condition in the literature. Therefore, before such a trial was conducted, a survey was sent to experts in the field of lactation, the members of The Academy of Breastfeeding Medicine, on the diagnosis and treatment of thrush in the breastfeeding mother and baby. Results showed that the majority of respondents relied primarily on history and physical examination of the baby, but not the mother, to make the diagnosis. Laboratory tests were ordered only rarely. The most common initial treatment was oral nystatin for the infant and cream for the mother's breasts. This was followed by oral nystatin for the infant and oral fluconazole for the mother. Treatment of recurrence or persistence was again most commonly nystatin for both mother and infant, followed by oral nystatin for the infant and oral fluconazole for the mother or oral fluconazole for both. In the absence of controlled trials of this condition, these results may serve as suggestions for the clinician, until definitive data are available.

Gravidez, Aleitamento e Fármacos em Dermatologia: Tratamento Tópico

“…37 Embora não haja informações sobre a excreção da nistatina no leite materno, a maioria dos autores considera aceitável o seu uso em lactantes, uma vez que é praticamente indetetável no plasma materno após a sua ingestão. 38,39 Opções de segunda linha em infeções fúngicas superficiais durante a gestação incluem o clotrimazol e o ciclopirox, que não mostraram potencial embriotóxico em modelos animais, mas dispõem de menor evidência científica da sua utilização em mulheres grávidas (categoria de risco B pela FDA). 33,40 A absorção transcutânea para a circulação sistémica do clotrimazol e do ciclopirox são mínimas, sendo por isso improvável que afetem o lactente.…”

Isolamento de Candida spp. no mamilo de lactantes do Banco de Leite Humano da Universidade Federal do Ceará e teste de susceptibilidade a antifúngicos

“…A levedura mais comumente isolada em nosso estudo foi a C. albicans. Quando este patógeno infecta mães lactantes, o ato de amamentar se torna extremamente doloroso, o que pode levar a um desmame prematuro (6) .…”

“…Em estudo realizado por Brent (6) , o tratamento mais comum da candidíase mamária foi nistatina creme para a mãe e nistatina oral para o bebê. Segundo Bodley et al (5) , a candidíase mamária pode apresentar uma refratariedade ao tratamento com nistatina creme, sendo necessário o uso de fluconazol oral.…”

Detecting Candida albicans in Human Milk

“…Superficial and localized breast yeast infections (mammary candidosis) in lactating women have been reported (1,2). The diagnosis and management of candidosis in the breastfeeding mother and infant are challenging (5). Mammary candidosis is most often presumptively diagnosed by signs or symptoms such as burning or shooting pain in the breast during and after feedings and persistently sore or cracked nipples that do not heal (11).…”

“…Mammary candidosis is most often presumptively diagnosed by signs or symptoms such as burning or shooting pain in the breast during and after feedings and persistently sore or cracked nipples that do not heal (11). In a recent survey of 312 physicians in the Academy of Breastfeeding Medicine, 95% of family practitioners and 87% of obstetricians/gynecologists did not use laboratory tests to diagnose mammary candidosis (5). However, diagnosis of mammary candidosis based on symptoms alone may be erroneous, as it has been shown that breast pain is frequently associated with Staphylococcus aureus infection among breastfeeding women (1,12).…”