I, too, am interested in the mastitis discussion.  I think antibiotics are
way overused and wish we had more research on when they are truly
indicated.  I recently had a call from a mother concerned about her
recurrent mastitis.  She had had four "infections" within a couple of
months and been on three different antibiotics.  When I quizzed her it
sounded like she had never had more than a plugged duct--never any fever or
flu-like symptoms, just a sore spot and redness on her breast.  She had
never been seen by her MD, just treated over the phone.  She thought she
had been doing good by catching the "infections" early.

I have never seen an abcess, but stories like Pat Gima's make me nervous.
When I get a call for advice I tend to go on how bad the mom is feeling.
If she has a fever over 101 degrees F and is feeling quite ill, I refer her
on to her MD, who always prescribed antibiotics.  If she doesn't feel
awful, just has a red and sore breast and low-grade fever I suggest she
start taking ibuprofen (monitor temp just before taking each subsequent
dose to make sure it doesn't spike up), use hot moist compresses before
feeds, gentle massage if she can feel a lump, and start most feeds on the
affected breast with baby's chin pointed at the sore spot.  Most of the
time that takes care of it.  Personally, I think the ibuprofen is the most
helpful.

Becky Krumwiede, RN, IBCLC, Appleton, WI
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