I usually find that treating these moms with antibiotics for an 
intraductal bacterial infection works well. Cephalexin usually won't 
work because the organism is coagulase negative staph, usually resistant 
to cephalexin.
I suggest a sterile breastmilk culture, then start on TMP sulfa bid. She 
should notice about 30-40% improvement in 2 weeks, and I would continue 
it until her pain is gone, usually about 6 weeks minimum. Sometimes 
women get a good initial response, then it worsens, and at that point I 
would change antibiotics.
Anne

Anne Eglash MD, FABM, IBCLC
Clinical Professor
Dept of Family Medicine
University of Wisconsin School of Medicine and Public Health
600 N. 8th St.
Mount Horeb, WI, 53572
608-437-3064 (O)
608-437-4542 (fax)
608-550-3054 (pager)



Date: Wed, 19 Dec 2012 19:55:57 -0500 From: Amy Macke 
<[log in to unmask]> Subject: Mother desperate-Pain in breasts that is 
persistent Permission to post. A former colleage has called me to get my 
opinion on her situation. I am stumped. She nursed her first child for 
over a year and had a wonderful and uneventful time. She does not want 
to stop nursing. She has been told by a few professionals "it just may 
not work this time" She says this is an unexceptable choice for her. 
Below is her story. She said the LC at the hospital she delivered said 
the latch was great,there was no sign of TT and her daughter is growing 
well. I did ask her if she ever pumps. She said she does and the pain is 
significantly less with pumping but the pain between pumping is almost 
constant. No nipple damage. I have not personally seen the baby because 
we are not in the same town. I would really appreciate any suggestions 
if someone has encountered a similar situation in their practice. Amy 
Macke RN, IBCLC Here is her account in her words: Shortly after my milk 
came in, I began feeling like I had broken glass in my nipples while 
nursing. Between feedings it felt like my breasts were on fire. I 
started a 10 day course of diflucan. After no relief, the doctor added a 
second 10 day course of diflucan and I also treated the baby with oral 
nystatin after seeing Lactation. 5 days into the second round of 
diflucan I was still not feeling any relief and the doctor prescribed a 
7 day course of keflex to rule out mastitis and I was given APNO cream 
to apply after each feeding for two weeks. This also provided no relief. 
I again talked with Lactation and the possibility of Raynaud's was 
discussed. Three weeks post-partum, the doctor sent me to a Breast Care 
Center for more specialized care. I was told I did not have an 
overwhelming infection and that if I couldn't handle the pain I should 
stop nursing. I again called the doctor and was told to wait it out over 
the weekend and if it was still painful the following week, I would be 
prescribed a two week course of procardia to rule out Raynaud's. Four 
days into the procardia and six days off of diflucan, the pain became 
almost unbearable to breastfeed through and I was not sleeping due to 
the burning between feedings. I called the doctor and was told to wait 
it out. I then talked to a family friend and FNP and she called in a 14 
day course of diflucan with a 400 mg loading dose on the first day. The 
baby is also being treated again with nystatin to prevent passing it 
back and forth, although she shows no signs of thrush. Five days into 
the 3rd round of diflucan I am feeling quite a bit of relief. The left 
side is now pain free during breastfeeding and the right side is at 
least bearable. I still feel some burning between feedings. I also seem 
to get plugged ducts easily, even though the baby completely empties 
both breasts at each feeding. Am I missing something? 
**********************************************

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome