AMW asked
What dose of diflucan is usually prescribed for a yeast infection on the breasts that has not responded to other treatment?
Answer
Diflucan (fluconazole) is a systemic anti-fungal agent that can be given orally, or less commonly, via intravenous infusion. It is used to treat a variety of fungal conditions including candida, a type of yeast. It is not often used for fungal infections (e.g. candida) of the nipple and breast ductal system (also known as the lactiferous ductal system) but has been utilized successfully for resistant infections.
Common symptoms of fungal infections of the nipple/ductal system include:
- Burning or pain of the nipple and areola
- Sharp pain in the breast area that radiates through the back and shoulder
- Flaking skin along with redness and inflammation
Treatment Of Local Candida Infections Of The Nipple/Breast
For non-systemic, local infections of the nipple area, Diflucan (fluconazole) typically isn't utilized and treatment can be successfully completed with a topical anti-fungal product such as nystatin, clotrimazole or miconazole. If an indiividual does have a candida infection and is breastfeeding, the infant is generally treated with Diflucan (fluconazole) to eliminate potential thrush infections from occurring.
Treatment Of Systemic Breast Fungal Infections
Fungal infections of the lactiferous ductal system (also known as mammary candidiasis) are not common. In fact, there is considerable controversy as to whether or not candida infections of the breast are responsible for symptoms individuals experience. For example, one study postulates that yeasts and candida play no significant role in breast infections. Instead it is more likely that bacterial infections such as staphylococci and streptococci are responsible.
However, this may simply be due to the lack of confirmed diagnosis's due to the fact that lactoferrin, a substance naturally present in breast milk, inhibits the growth of candida. It is thought by some that infections could be essentially "hidden" from laboratory findings but still be present.
Nevertheless, Diflucan (fluconazole) has been used for suspected mammary candidiasis successfully. Although it isn't approved by the FDA for this indication, Diflucan (fluconazole) is often used for treatment, .
In terms of dosage, Diflucan (fluconazole) is a "fungistatic anti-fungal agent", meaning that is stops fungus from multiplying and proliferating by affecting the fungal cell membrane. It doesn't directly eliminate fungal infections. Due to this mechanism of action. Diflucan (fluconazole) generally must be used for at least 2 to 3 weeks to completely eliminate mammary candidiasis.
The exact dosage varies by individual, but Diflucan (fluconazole) is commonly dosed as follows:
- 400 mg as a single loading dose followed by 100 mg to 200 mg daily for 14 to 121 days
This certainly is quite a wide range, but this is mostly due to the fact there there is no approved dose for this indication and dosing is generally based on practitioner experience and anecdotal evidence. Some sources recommend using Diflucan (fluconazole) for at least one full week after symptoms disappear.
If you are breastfeeding, it is important to know that Diflucan (fluconazole) is excreted into the breast milk but multiple studies show that the amount excreted is safe for the infant. In addition, the American Academy Of Pediatrics considers it "generally compatible with breast feeding".
