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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