I see this pretty often around here due to doctors undertreating the
mastitis in the first place and each continuing time, too. The doctors in
our area will prescribe 7 to 10 days of amoxicillin, Mom will take it, feel
better, then two or three weeks after the medication is over, get mastitis
again, then the doctor prescribes the same thing!! I think this very often
happens because the mother is seeing different doctors in the practice each
time coupled with plain old ignorance on the doctors' part. I see recurrent
thrush with the same history: mother goes to doctor, doctor doesn't diagnose
thrush until mother is in agony, then prescribes something like nystatin
topically for a few days -- arrrrggggghhhhhh.
So, I would ask the mother for details of past treatment. I've had some
success writing a consult letter to the doctor detailing my interaction with
his patient and making recommendations for future treatment for his
consideration. The doctors I've done this for have taken my advice and
greatly improved the outcome. We're not doctors and we can't prescribe
medications, but we can recommend things to the doctor, i.e. "Due to
mother's history, you may want to consider rigorously treating mastitis at
first symptoms with a wide spectrum antibiotic with little resistance such
as ___________, which is generally given ___mg ____ times per day to prevent
recurrence of the infection, and is approved for use in breastfeeding
mothers by the AAP. [reference to Hale]."
Melanie Young,
LLLL, IBCLC
Smithfield, NC
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