A posted a case almost a year ago, about a client of mine with severe
bilateral mastitis which cultured up in the breastmilk as beta strep, blood
cultures were negative.  You can do a search for the details, it was a case
I'll never forget.  Anyway, she was hospitalized and placed on IV antibiotics
for a few days and oral ATB at home.  The baby was asymptomatic and receiving
her breastmilk all week.  There was great disagreement about whether to treat
the baby and whether she could continue to breastfeed.

I consulted with some experts myself who strongly recommended that the
breastfeeding continue along with the infant being treated for at least 10
days, symptomatic or not.  I passed this information on to her and her
physicians.

In the end, the baby was never treated and thank god never became sick from
Beta Strep.  She stopped breastfeeding because she was told that there was no
guarrantee if she continued to nurse that the mastitis would not reoccur.
 Mind you, she was a very sick woman.

Even though, the doctors involved refused to treat the baby unless he was
symptomatic,  she was told that if her son even had as much as a cold within
the first 3 months of age, she was to bring him immediately for treatment and
he would then be placed on ATB and might need hospitalization.  Needless to
say, she was really scared for months.

The scenario I would have liked to see would have been to continue
breastfeeding and passing those antibodies on through the milk,  treat both
mother and baby intensively for at least 10 days with antibiotics to avoid
re-infection and preserve the breastfeeding relationship.  Then keep an eye
on things.

Breastfeeding is an essential part of the treatment unfortunately it was not
seen that way.

It was one of my most difficult (emotional and clinical) cases.  I truly
ached for that mother and baby and the loss of their breastfeeding
relationship.

Maria Parlapiano RN, IBCLC
the Lactation Resource Center, inc.,  Chatham, NJ