Thrush in the breastfeeding dyad: Results of a survey on diagnosis and treatment

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.