Quick question - Daktarin

[MummyDayDream]

Just been prescribed Daktarin for thrush, as sore nips (ouch!) - although no sign of any symptoms in ds (GP checked him thoroughly). Anyway, the tube of cream just says to use twice daily - do I have to wash it off before feeding?
Thanks.

Not sure, so bumping this for you - but do know that it shouldn't just be you being treated - has DS had the oral gel prescribed for him? He can still have it without having any symptoms and will just reinfect you.

Bump! (She whispered hopefully, feeling cheeky but desperate.....)

dd1 had an orange flavoured oral gel when she had thrush.

Look here for the best information - In my experience Daktarin is not the most efficient way of treating thrush....

Here you will also find a comparison between Nystatin and Datkarin

Many thanks for your replies, especially the links. I'm now rather bemused, as my GP was adamant that there was no need to treat ds, yet the information I've now read makes it clear that we both need treatment. My GP is normally absolutely fantastic, and she spent a lot of time with us today. Maybe she thinks I'm imagining things??????

Hi I too have been left very confused as have been represcribed nystatin ointment and was also given nystatin suspension to have at hand incase ds begins to show signs of thrush in the future. The links suggest nystatin is harmful? Should I treat us both.

I used to use daktarin on me, and nystatin in ds's mouth.

Our battle with thrust went on for months though (sorry for the downer), as I had thrush down below as well which wasn't properly clearing up, and apparently they are all linked.

A course of 4 pessaries eventually kicked it on the head, but I was on the verge of starting the tablets (can't remember the name), so keep pressing if it doesn't go away. I had to see numerous GP's before I got one that treated us both.

MummyDayDream - I was told I didn't have to wash the daktarin off. However, on another occasion I was prescribed canesten cream for use on nipples, which should be washed off. HTH.

If one of you has thrush, both (or even partner too if applicable) should be treated, even if there are no symptoms.

You need to treat DS with something too so you don't infect/reinfect each other. I was told to wash off the cream before feeds however I usually forget and dS seems OK . I put it on after every feed - not just twice a day.

In my experience, it's not a very good solution. I've had thrush on & off for weeks now - and it only ever seems to keep it 'manageable' but never clears it completely. My GP(s) have refused to prescribe the tablets on several occasions but at the next flare up I'll be back to pester them again!

Hi suzi2 do you use nystatin or something else?

Many thanks for your wise words. Perhaps my GP was distracted by worries regarding how she would get home in the snow.....

You need to wipe the cream off before feeding again but you do need to get some treatment for your DS too as otherwise he will just pass it back to you again.

Hi pookey. I use Daktarin cream, DS uses Daktarin gel. He seems to enjoy the gel now - weird baby!

i was told i didnt need to wash it off....

will just clarify....told NOT to wash off daktarin cream but MUST WASh off canesten cream

i was instructed to use the daktarin after erach feed and there was no need to wash it off. Dd2 was prescribed the nystatin drops BUT Gp said if I could not get those drops to give dd2 doses of the daktarin oral gel... as it is an oral gel - if you have that one - no need to wash off.

Agree with Hunker you need to treat him too. It will be passing from one to the other. The doctor really should know better. You need nystatin drops for him.
This is a great resource on the subject.
Good luck.

Just to re-iterate....

Two of us have given you links to the BFn's leaflet WORTH A READ!!!!
And Nystatin is NOT as good as miconazole (which I only Just relasied is the same as Datkarin )

Nystatin

In the revised leaflet reference to the use of nystatin tablets and suspension has been removed. Nystatin is very poorly absorbed from the gut and the mechanism by which it could treat breast thrush in the mother is unknown. It is acknowledged to produce very slow cures (generally 10-14 days) and a high number of re-occurrences have been reported. The inclusion of nystatin in the original leaflet was a compromise, in that it was a well-known drug which provided an alternative to the lesser-known and more controversial fluconazole. The reported results of its use, are so poor that we felt it was unethical to include it in the updated leaflet.

Nystatin suspension is widely prescribed for oral thrush in infants. It is often associated with some sickness and colicky pains. It is difficult to achieve sufficient coverage of the baby's cheek pouches using the dropper often supplied and it tends to be squirted onto the back of the tongue rather than coating all surfaces of the mouth. Nystatin is not licensed to be given to babies under month because of the potential risk of the baby choking if the dose is squirted into the mouth too quickly. The maufacturers have safety data on file to support earlier use (personal communication, Squibb)

Hoppe et al (1997) conducted a comparative study of nystatin suspension vs miconazole gel to treat oropharyngeal candidiasis.

A total of 227 infants were randomly assigned treatment of gel or suspension four times a day after feeds. Fifteen children whose diagnosis was not confirmed by culture were excluded from the study and a further 29 were excluded due to violation of the study protocol. The results of the study are shown in the table below as clinical cure rates. The results are clinically significant to p< 0.0001.

Relapses with 4 weeks of cure occurred with similar frequency in both treatment groups (12.4% nystatin, 13.0% miconazole). Premature cessation of treatment due to side effects occurred in 4 children (1 miconazole, 3 nystatin). There was no placebo arm to the trial as it was deemed unethical. The dose of nystatin used in the study was 100,000 units (1ml) four times a day and miconazole 25mg (1.25g of a German product InfectoSoor20mg/g miconazole cf Daktarin gel 24mg/ml) four times a day. Nystatin was significantly more efficacious in eradicating yeast from the gut and reducing rectal cultures of yeast. Absorption of both agents from the gastrointestinal tract is low. Both agents produced typical side effects of nausea, vomiting and diarrhea. The main study author, Hoppe, concluded that nystatin suspension is significantly inferior to miconazole gel with regard to clinical outcome, speed of cure and oral yeast eradication. It is difficult to compare the bioavailability of the German product with the one available in the UK as no dose recommendations are available.

In light of these results we felt that the superiority of miconazole should be highlighted.

Fantastic info there pupuce. I know what I won't be using if I get thrush with this baby

There must be a daktarin cream and gel? I only ever had the gel which didn't need to be washed off as you could use it in the baby's mouth anyway. You can (well could when ds was a baby) buy this OTC without a prescription if necc (so if you start to suspect thrush at a w/e!). We suffered for so long that I keep a supply of daktarin, canesten cream and pessaries in the house as I dread getting it as badly again.

One more point - when I couldn't get any joy from the new GP (moved house), I mentioned it to the HV. They can prescribe canesten cream, pessaries and daktarin (prob nystatin too FWIW). They're sometimes easier to access, but mine just leaves a prescription at the HV reception for me when I ring up. Super easy

Brilliant info, thank you all.
Still shocked that my GP was so off the pace, though.

Mummy - haven't had time to read the other posts, but if you have not been prescribed Daktarin Oral Gel by the GP, please get a tube for your baby asap (no need for presription - you can buy it in most chemists). It's an orange flavoured gel which you rub into the baby's mouth. I was prescribed Nystan, which didn't work. I found out about Daktarin on the internet (as usual !!)

My GP was going to prescribe for my son only, and I had to ASK her for something for my nipples too, she didn't realise that you can cross-infect !!

I used both products for about 4 weeks to be 100% sure - keep going about a week after symptoms have cleared as thrush is extremely tough to get rid of.

Oh, and no need to wash off Dakatrin cream off your nipples. Rub it in about 30 mins. before a feed and leave it.
Good luck !

pupuce - excellent info. - I read this too when my son had thrush about a year ago and it convinced me to ditch the Nystan prescribed by my GP. I got Daktarin off the shelf in the chemist and it did the trick !!

sorry, forgot to add some other tips which I found useful in preveting cross-infection:

husband and put away hand towels and washed hands more often than before and dried off with paper towels instead

don't use anti-bacterial soap or washing up liquid - these kill the GOOD bacteria

wash all clothing in at least 60 degree hot water - thrush is only killed at 50 degree temps. and above

best way to kill thrush in expressing equipment and baby feeding stuff, etc, is to boil in a big pan for at least 20 mins. (steam sterilising does not kill thrush) or use Milton sterilising solutuion or tablets, see below

I didn't know about Milton disinfecting stuff, but have since realised by reading the small print on their products, that it kills the thrush bacteria, so use it for kitchen surfaces, baby high chair, etc.

A good natural remedy for nipples, is a very light vinagr solution (one part vinagar to 10 parts water) of course only use if nipples not cracked or really sore !! I used to dab some on straight after each feed and then put canestan cream on as well

ps - someone mentioned canestan - I read somewhere info, by a leading bf doctor that it can be left on nipples as only minute amounts get absorbed into the baby - obviously don't put on just before a feed - but if it has been rubbed in well at 30 mins. before a feed, or even better, AFTER each feed, no need to wash off

wow I have been doing everything wrong! Am going to ask for daktarin and chuck the nystatin.

also gonna start following your tips nanneh