From the Guidelines
Candidiasis of the nipple during breastfeeding should be treated with antifungal medication for both mother and baby to prevent reinfection, with fluconazole being a safe option for breastfeeding mothers, as indicated by the American Academy of Pediatrics 1. The causes of candidiasis of the nipple in breastfeeding mothers are not fully understood, but it is thought to be related to the overgrowth of Candida albicans, which can be triggered by factors such as antibiotic use, hormonal changes, or nipple damage 1. Some key points to consider in the treatment of candidiasis of the nipple in breastfeeding mothers include:
- Applying topical antifungal cream such as miconazole or clotrimazole to the nipples after each feeding, continuing for at least 7 days after symptoms resolve (typically 2-3 weeks total)
- Using nystatin cream as an alternative for topical treatment
- Prescribing oral fluconazole 150-200mg as a single dose, followed by 100mg daily for 7-14 days for more severe cases
- Giving nystatin oral suspension (100,000 units/mL) to the baby as 0.5-1mL to each side of the mouth four times daily for 7-14 days
- Continuing breastfeeding during treatment to prevent breast engorgement
- Practicing good hygiene, such as washing hands thoroughly before and after breastfeeding or applying medication, and sterilizing pump parts, pacifiers, and bottle nipples daily
- Air-drying nipples after feeding and changing nursing pads frequently It is essential to note that breastfeeding is not recommended for mothers on azole antifungals other than fluconazole 1. Symptoms of candidiasis of the nipple in breastfeeding mothers can include painful, red, shiny nipples and shooting breast pain, and treatment should be continued for the full course to prevent recurrence.
From the FDA Drug Label
A published survey of 96 breastfeeding women who were treated with fluconazole 150 mg every other day (average of 7. 3 capsules [range 1 to 29 capsules]) for lactation-associated candida of the breasts reported no serious adverse reactions in infants.
The cause of candidiasis (fungal infection) of the nipple in a breastfeeding mother is lactation-associated candida. The treatment is fluconazole 150 mg every other day. Caution should be exercised when fluconazole is administered to a nursing woman 2.
From the Research
Causes of Candidiasis
- Candidiasis of the nipple in breastfeeding mothers can be caused by Candida albicans, which can lead to symptoms such as burning, stinging pain radiating from the nipples into the breast, and hyperkeratotic areola and nipples 3, 4.
- The diagnosis of candidiasis is often based on subjective signs and symptoms, and can be difficult to confirm with biological tests 4.
- Other conditions, such as subacute mastitis/mammary dysbiosis, nipple bleb, dermatitis, vasospasm, milk crust, hyperlactation, and postpartum depression, can also present with similar symptoms and should be considered in the differential diagnosis 5.
Treatments of Candidiasis
- Antifungal medications, such as fluconazole and nystatin, are commonly used to treat candidiasis of the nipple in breastfeeding mothers 3, 6.
- Topical yeast medications, such as tristatin ointment, can also be used to treat candidiasis of the nipple and areola 3.
- In some cases, treatment with antifungal medications may need to be continued for an extended period, such as 6-8 weeks, to resolve the infection and accompanying pain 3.
- Discontinuation of antifungal medication and treatment of alternative diagnoses, such as subacute mastitis/mammary dysbiosis, nipple bleb, and dermatitis, can also lead to resolution of symptoms 5.
- Pain management, such as with hydrocodone bitartrate and acetaminophen, may be necessary to allow the mother to continue breastfeeding while being treated for candidiasis 3.