In the UK antibiotics are only available on prescription so a doctor would have to prescribe.  Pharmacists don't prescribe.  There is an
increasing hesitance to prescribe antibiotics, I think doctors are getting much more careful.

I would support Joy's comments on mastitis - I think there is good evidence for many (the majority?) of cases of mastitis being
inflammatory rather than infectious.  My understanding is that poor drainage could mean milk leaking back into the breast tissue under
pressure, the mother's body recognising a 'foreign body' and setting up the inflammatory response in consequence.  I don't see that
there would have to be a 'plugged' or blocked duct first, though that is often the case.  I understand that antibiotics do have an
anti-inflammatory side-effect, hence their success.  Of course if the physical root cause is not addressed this also explains why mastitis
tends to recur.

There are guidelines from the Royal College of Midwives about when mastitis 'should' be considered infectious, - something about
number of leucocytes? - is this a quicker test than looking for the specific organism?

We know that poor positioning damages nipples, and also drains the breast poorly - while I (as a lay counsellor) would always
recommend a visit to the doctor, I would also hope to address the cause fo the problem, with a view to preventing recurrence.

Maureen Minchin's 'Breastfeeding Matters' is a good (if challenging) read on mastitis.


Mary Broadfoot, Scotland
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