Help! Recurrent thrush problem, 21 week old EBF twins...
DT2 is now onto his third round, patches inside cheeks have finally appeared. I started with a sore nipple 2 days ago but aside from a rather coated tongue couldn't see anything definite in his (or sisters) mouth. I became convinced it was the same problem again last night and slapped some clotrimazole on, sure enough, he now has the patches.
Both babies have had 2 rounds of nystatin previously, and I've had fluconazole. I'm sure by tomorrow the nappy rash will have started too... Interestingly DT1 has never had any (obvious) infection in her mouth but did get the typical nappy rash last time so I'm sure she does carry it too.
Is there any OTC option for the babies as far as anyone knows? It seems a long time until Monday! We did use the walk in centre once because of nipple-shreading but I'd feel uncomfortable at this time of year since its not even close to an emergency.
Anything we can do to prevent it happenings again? They're in real nappies but habitually (because of this!) washed at 60 with a scoop of sanitizer, being careful about towels etc, they don't have an allocated boob though, so I wonder if that might help? No dummies to share, but the girlie one will occasionally finish her brothers EBM bottle, will stop that.
The Breastfeeding Network recommends miconazole gel (Daktarin oral gel - available OTC) rather than nystatin for oral thrush in babies as studies have shown it's the more effective of the two treatments. It needs to be applied four times daily to each of your babies' mouths - use four petit pois-sized blobs at each application, one each for the tongue, roof of the mouth and each cheek. Use Daktarin (miconazole) cream for yourself, applied after every feed - this is also available OTC. Let as much air get to your boobs as you can - I'd go around with 'the girls' out for 15-20 mins after every cream application <glamour> Avoid using breast pads as they're not very breathable and make sure you wear a clean bra every day.
The only OTC fluoconazole you can get is the one for internal thrush. I have no idea if that dosage is appropriate/safe for BFing so I'd avoid taking anything orally until your GP can prescribe you the appropriate course of medication. You'll need to be using the topical treatment at the same time anyway, and for two weeks after symptoms have resolved, so there's no harm in getting going ASAP with the gel and cream then making an appointment with the GP when you can.
Thrush is such a misery. I had it for weeks, but NOT while BFing twins! Well done you
PS Re-read your OP. Use whatever clotrimazole you've got on the nappy rash but get the miconazole (Daktarin) cream instead for yourself. It penetrates the nipple better (again, this is advised by the BfN). I think the advice is also to try and avoid bottles altogether during thrush episodes or at least be absolutely assiduous about washing and sterilising. As thrush is systemic, I don't think having a designated boob for each twin would make any difference as it's in your milk as well as the nipples and ducts of each boob (but that's just me making a guess).