Mom I've worked with in the past was diagnosed with bilateral mastitis on
Oct. 26 and prescribed Augmentin. Her symptoms included hardness of the
breast, red area that started on the bottom side and then spread all the way
around the nipple in a 3 inch diameter, painful ache, no fever. Because it
appeared that she was overproducing, we also experimented with using
peppermint tea to help bring down the production and secondary overfullness
that might have caused the problem. Between the tea and the antibiotic,
mother was feeling much better after 4-5 days. Her breasts softened, the red
area lessened, and the ache almost went away. Almost, but still some redness
and pain.
During this therapy, mom's nipples also became itchy, so she was treated
with Nystatin (mom used just for a few days) and they cleared up; itchiness
has not come back. No other yeast symptoms in mom or baby.
Augmentin ran out Nov 6, mom was put on Cephalexin Nov. 10, and since then
the situation has worsened, with the ache increasing again. Breasts continue
to be soft and comfortable, supply under control with 1 cup of peppermint
tea daily before bedtime.
Initially I had pondered whether a milk culture would be helpful or not. It
seems to me that if the infection is in the ducts, the milk will contain the
offending organisms; however, if the infection is in the tissues
(cellulitis), it is less likely that the milk will culture out. Mom's
"infection" has appeared to be cellulitis, so I have not strongly pushed
culturing up to now.
Given the lack of total resolution, what should be the next step? It was
mentioned early on to mom that if she did not clear up, they might have to
hospitalize her and do IV gentamicin. Mom is not in horrible pain, but
rather a chronic situation, and I would hate to see her hospitalized and
separated from baby (who is now 4 mos) if it isn't necessary.
One other aside: mom is also concerned that baby has developed constipation.
He had been feeding every 1-2 hrs but has stretched out to 2-4; he has had 2
BMs since Saturday, both very, very thick and hard to past, with some "green
sections." Wet diapers are copious, baby otherwise eating well and
apparently content. According to Hale, the potential side effects of
cephalexin are *diarrhea*.............. and baby is exclusively breastfed.
????
I cannot see the mother as I am leaving town this afternoon; she will be
making an appt with her OB for further evaluation, and I am gathering as
much info as I can for her before she goes in. Thanks to all who can help.
Lisa Marasco IBCLC
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