Dear wise ones

I am supporting a mother by email since last Wednesday, and have 
permission to post.  Her baby is 10 weeks.  The mom has been 
suffering severe bilateral nipple and breast pain for 6 weeks and was 
treating for Thrush, including a 10 day course of Fluconazole.  The 
pain persisted in spite of the Fluconazole which is when she contacted me.

I described nipple/breast? thrush and suggested that if the pain 
hadn't resolved in all this time, then she should contact her doctor 
and request a nipple swab and milk culture.  She did.  Last Friday 
the milk culture came back positive for S Aureus and the doctor 
immediately prescribed flucloxacillin.  Over the weekend the pain 
lessened a bit and mother was feeling relieved.  Today her doctor 
contacted her again to let her know she has MRSA of the nipples.  He 
is prescribing topical mupirocin. The baby has been examined and is 
asymptomatic.  The doctor has contacted a microbiologist to confer, 
but everyone seems uncertain about whether continuing to breastfeed 
is safe for the baby.  And the mother is about ready to wean, being 
concerned for her baby and wondering whether continuing to breastfeed 
is worth it.   Her baby has been receiving 1-2 bottles/24 hours for 
the last week or so.

A search of the Lactnet archives doesn't throw up a lot, but it seems 
that continuing to breastfeed might be safer for the baby than 
weaning at this point.  And for the mother, in order to avoid 
continued/worsening of the breast infection and possible abscess.  In 
your opinions, is this correct?

If the mother stops breastfeeding, she wonders if it is safe for the 
baby to have her expressed milk?   I wonder whether it would be safer 
for her to pasteurize it (to inactivate any infectious organisms) or 
whether it would be safer for the baby to have the full complement of 
antibiodies to the MRSA that she is surely producing after all these weeks??

Any help and information would be very, very gratefully received, 
including usual antibiotics for MRSA (is flucloxacillin sufficient to 
treat this?)    Thanks so much!

Pamela Morrison IBCLC
Rustington, England

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