Nipple and breast thrush - Antibiotic Prescribing

Comment from expert advisory group

  • The use of all-purpose nipple ointment is not recommended as treatment option.
  • It is important to treat both the mother and baby if a breast-fed baby has oral thrush but the mother has no symptoms. Similarly, if mother has symptoms, treat breast-fed baby also even if no signs of thrush in baby’s mouth.
  • Second line systemic fluconazole should only be used in exceptional circumstances and under medical supervision for deep candida mastitis which is very rare.
  • There is a significant risk of drug interactions and caution must be exercised when using fluconazole.

Treatment

Drug Dose Duration +/- Notes
1st choice options
Miconazole Cream for mother Apply cream to nipple and areola. See Notes Apply after every feed.  Continue for at least 7 days after symptoms have cleared.
Nystatin oral suspension for baby

1ml dropped into the mouth four times daily after feeds.

  Duration usually 7 days (48 hours after lesions have cleared).

Miconazole gel for baby

 

 

 

 

 

 

Neonate: 1ml two to four times daily after feeds*.

2-3 months: 1.25ml to be applied four times daily after feeds*.

≥4 months: 1.25ml to be applied four times a day after feeds. 

The dose should be divided into smaller pea-sized portions; gel should be smeared in baby’s mouth after feeds with a clean finger, ensuring there are no clumps of gel in the mouth.

See Notes

 

 

 

 

 

 

*Unlicensed use in infants < 4 months due to choking risk. Lower age limit increased to  5-6 months for infants who are pre-term or exhibiting slow neuromuscular development.

If prescribed for infants < 4 months, ensure counselling on administration provided.

The gel should not be applied to the back of the throat due to possible choking.

Gel should never be given by spoon or syringe.

Continue for at least 7 days after lesions have cleared.
2nd choice options

Fluconazole

 

    Should only be used in exceptional circumstances and under medical supervision for deep candida mastitis which is very rare. There is a significant risk of drug interactions and caution must be exercised when using fluconazole.

Nipple and breast thrush Antibiotic Prescribing May 2022.pdf (size 285.7 KB)

Patient Information

Safe Prescribing (visit the safe prescribing page)

Reviewed May 2022

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