A wound that won't heal is contaminated or being re-traumatized, or both.
The keflex may not be the right drug for the bug.  The fact that the cut
looks clean doesn't mean it isn't infected.  The milk probably washes it off
and the baby is sucking it off as well. I've been seeing more and more
stubborn and resistant cases of mastitis.  If the nipple cracks very early
on and won't heal, I would always suggest discussion with theHCP about
treating first with an antibiotic rather than suspecting fungal infection,
which usually occurs later on. While diflucan gives some of these moms
slight relief, it probably is the anti-inflammatory and slight anti-biotic
effect that drug also manifests. If appropriate abx tx is really delayed
then sometimes the infections are more difficult to erradicate.  The mother
can seek a second medical opinion and not wait for a culture but just try a
stronger (or different) abx.  Once the nipple gets this badly damaged,
sometimes resting it until it is well-healed (not just a day or two) is the
best course.  I would rinse it in warm water after every nursing or pumping
to flush the wound (as is standard in wound care and which Kay Hoover and I
describe, thoroughly reference, and recommend in The Breastfeeding Atlas.)
The baby could be cultured to see if that is where the re-colonization is
coming from.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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