Nipple candidiasis during lactation
Fungal infection of nipples and milk ducts by Candida albicans. Per ABM Protocol 26 (2022) and AEPED 2023, a controversial diagnosis – some so-called «nipple thrush» is vasospasm or dermatitis. Milk culture confirmation is debated. Symptoms: burning nipple pain during and after feeds, radiating into the breast, white plaques in the infant's mouth (concurrent oral candidiasis). Treatment of mother + infant simultaneously: topical miconazole or nystatin on nipples, oral nystatin or fluconazole for the infant.
ICD-10 B37.82 drugs
Also known as: Nipple thrush, Mammary candidiasis
Drugs used for this condition
- BMiconazoleFirst line · Imidazole antifungalNipple candidiasis. Per ABM Protocol 26 2022, topical 2% cream to nipples 4 times daily after feeds for 14 days. Alternative to nystatin, especially when non-albicans Candida is suspected. Treat the infant in parallel with oral nystatin.
- BNystatinFirst line · Polyene antifungal antibioticNipple and milk duct candidiasis. Per ABM Protocol 26 2022 and AEPED 2023, topical cream or suspension to nipples 4 times daily after feeds for 14 days. Simultaneously to the infant – oral suspension 100,000 IU/mL, 1 mL 4 times daily for 14 days. Without simultaneous mother-infant treatment, recurrence is inevitable.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit