Janet Bergeson wrote:
>Also, I have seen many moms recently with cracked nipples that have ended up
>with mastitis.  I was wondering if applying Bactroban on the nipples in
>addition to pure lanolin cream and the usual cracked nipple therapies would
>help avoid a mastitis.

This has reminded me of something I have often wondered about - this link
between cracked nipples and mastitis. I know conventional theory goes that
this is one way bacteria enter the breast to cause mastitis, but I find
this difficult to believe. It assumes the bugs get in and 'swim' upstream
through the ducts (and milk) to a blocked area. I have never been
comfortable with this concept. It just seems too unlikely. What do others
think?

An alternative explanation of the link, in my opinion, is that cracked
nipples are caused by a poorly attached baby, who does not drain the breast
well, therefore predisposing the mother to blocked ducts, which in turn
lead to mastitis. If this is the case, Bactroban, or any other
anti-bacterial preparation on the nipple should not make any difference to
the incidence of mastitis.

So non-infective mastitis is easily explained by blockage in the duct,
bank-up of milk, which leaks into surrounding tissue, causing inflammation.
But when it is considered infective, and antibiotics appear to work, where
have the bacteria come from, and how did they get there??? Can anyone
explain this to me?

OK, hypothesising here - Is it possible that there actually are no
bacteria, and somehow the antibiotics are having an anti-inflammatory
effect? I am no pharmacist or doctor, so I have limited knowledge about
drug actions, side-effects, etc. I may be totally 'off the planet' here,
but I thought it would be interesting to try anti-inflammatory medications
instead of antibiotics? Or are these worse for the baby than antibiotics in
the milk? I really do think in many cases the other recommendations during
mastitis, of draining the breast well, etc. probably do more to resolve the
situation than the drugs do.

I'd love to hear what other Lactnetters understand about the aetiology of
mastitis.

Joy Anderson IBCLC, NMAA Breastfeeding Counsellor
Perth, Western Australia
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