Hi Jaye,  I have some link to 2 free articles.  The first one is about chronic nipple pain and infections.  It is excellent.  The second one is the protocol on mastitis.
http://www.liebertonline.com/doi/pdfplus/10.1089/bfm.2006.0035
http://www.liebertonline.com/doi/pdfplus/10.1089/bfm.2008.9993
 
 I do have a couple of questions.  How old is the baby?  Has this mom been doing any pumping be fore you started seeing her?  In my experience, the cracking abound the base of the nipple is often seen with use of too small flanges.  Has she tried an 30mm flange?
 
Many MDs do not order cultures in a situation like this.  I was just reading an article about breast abcesses and they are not always cultured.  
I don't think that topicals are necessarily used along with oral antibiotics.  
You could have the mother consult with her pharmacist to confirm that this is a too high dose.  Mom could then call back to her  MD with this information.  I am concerned that you may be getting into a difficult situation with this mother and her doctor.  I hope that you can communicate directly with this MD.
 
I hope that some of the other MDs on the list can give you some info.  Sincerely, Rachel Wahl RN IBCLC
 
 
 
> Date: Sat, 28 Aug 2010 14:05:03 -0700
> From: "Jaye Simpson, IBCLC" <[log in to unmask]>
> Subject: Amoxicillan dose of 3000mg per day
> 
> Hi All,
> I need some fast answers. A client of mine has chronic sore nipples with a
> crack around the base of both nipples. Even with correct latch and
> positioning, and baby having no physical issues that would cause a problem,
> she is in pain. We took baby off the breast for two days because the pain
> was getting so bad (she acknowledged possible inadequate latch a few times
> on her part and just suffering through but not at every feed) and the cracks
> were not healing. Started her on (otc) APNO and pumping with hospital grade
> pump but pumping was hurting and there was no healing going on. She got
> larger flanges - didn't help. She got comfort shields - did not help. A
> week later.(was only supposed to be 2 days.) I encouraged her to go to the
> Dr and get a culture and rule out staph or some other bacterial or fungal
> infection. Here is where I am frustrated.
> 
> 
> 
> Dr refused to do a culture - said it would take too long to get results
> back. Instead he says she must have mastitis (with NO outward or other
> physical symptoms of mastitis), states it is definitely not fungal, and puts
> mom on oral amoxicillin at 1000mg 3 times per day and tells her to take baby
> OFF breast - pump and dump as Amox not safe while breastfeeding. Hale
> states that 875 BID is fine - but I can't find any info stating that nearly
> 2 times that dose is fine. I suspect it is.but I can't give her information
> on a dosage I don't have. Also - no topical antibiotic to assist with
> healing.
> 
> 
> 
> Now I have a mom who is afraid to take the medication, afraid to nurse baby
> or give him the milk if she does take the medication, and is tired of
> hurting and just wants to nurse her little one without pain.
> 
> 
> 
> All input greatly appreciated and the sooner the better. Mom is considering
> taking the high dose of amox and putting baby on ABM - even tho we discussed
> the risks of ABM, and the possibility of simply taking 500mg 3 times per day
> (which would be a standard and safe dose) and keeping baby on the breast.
> Quite frankly, I'd just like to know what is going on with her nipples.I
> suspect bacterial or fungal issue.but no one will culture her! Sigh.
> 
> 
> 
> Please e-mail privately at [log in to unmask]
> 
> 
> 
> Warmly
> 
> Jaye
> 
> 
> 
> 
> 
> Jaye Simpson, IBCLC, CIIM
> 
> Breastfeeding Network
> 
> Sacramento, CA
> 
> www.breastfeedingnetwork.net
> 
> 
> 
> 
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