Lately I've been seeing a lot of moms who have had early cracked nipples
with progression to mastitis.  By the time I have seen them, most have been
prescribed antibiotics over the phone (a bad practice, as Nikki points out.)
Often they get just a little better, but then the pain recurrs.  I think it
is because of antibiotic resistance.  It could be fungal, but with no other
appearances of sx and being unilateral, I would suspect poor response to the
antibiotic therapy. We've talked about chronic, sub-clinical mastitis on
this list before, and I worry about that due to the reduced immune status of
postpartum women.Often moms are prescribed inappropriate abx, inadequate
dosages and inadequate lengths of time.  I know it takes more time to do a
culture and sensitivity, but seeing what I've been seeing lately, I wish the
moms would all be seen by docs, have cultures taken. They could be started
immed. on a drug, but then switched if necessary if the cultures indicate
it.  Or baby's naso-pharynx could be cultured.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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