Thanks everyone.
Baby is 3 wks old now - mom had not been pumping prior - she started due to
nipple pain not resolving. She just couldn't bear to put baby on anymore.
I believe she started out with cracks due to shallow latch. However, even
with a good deep latch, they did not heal. Mom has rather inelastic nipples
which may very well be part of the problem - but, even with larger flanges
and APNO - no healing was occurring. :( She has not taken me up on my
request for a follow-up. I do need to see what is happening with pumping
and have repeated this several times but I can't force my way in to her
home...
I told her that the Amox didn't sound right to me - that diclox is what is
typically used. I also expressed concern for not doing a culture. But -
she is from a culture that does not argue with the Dr...and she is an
RN...what do I do? I told her I doubted the 1000mg 3x/day was an issue -
quoted Hale - but the Dr got her scared to 'harm her baby' with BF and amox.
This is when I wish I was an MD and could just take care of the moms
appropriately the first time around...ugh. But I am not going to med school
at 44!
I will be calling mom today, checking in and giving her the updated info.
We will see what she does. She really seemed to believe that giving ABM was
far better and less a risk than taking the amox... :(
Thanks again!
Jaye
Jaye Simpson, IBCLC, CIIM
Breastfeeding Network
Sacramento, CA
www.breastfeedingnetwork.net
-----Original Message-----
From: Anne Eglash [mailto:[log in to unmask]]
Sent: Sunday, August 29, 2010 8:05 PM
Subject: amoxicillin choice and dosing
Dear All,
Amoxicillin 1000mg three times a day is certainly not a problem for
breastfeeding, and is a common dose for adults.
Amoxicillin, however, is NOT an appropriate choice for mastitis or any
sort of breast infection, or for that matter, any sort of skin
infection, unless the culture proves that it will cover the bacterial
culprit. Amox generally does not cover staph aureus, which is the most
prevalent bacteria in breast infections!!! It used to cover a good % of
staph >30 years ago, but with the emergence of beta lactam activity of
staph, it is just basically wrong to use it in this situation. To put it
bluntly, it demonstrates a lack of understanding of basic infectious
disease.
Nipple lesions and mastitic breasts should be cultured, given the
prevalence of MRSA, and the possibility of other pathogens, such as
beta- hemolytic strep, and group B strep.
Anne Eglash MD
Clinical Associate Professor
Dept of Family Medicine
University of Wisconsin School of Medicine and Public Health
600 N. 8th St.
Mount Horeb, WI, 53572
608-437-3064 (O)
608-437-4542 (fax)
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