A woman called me yesterday with a plugged duct.  Baby is 2.5 weeks old.  I gave her the usual comfort/treatment measures.  Today, the plug seems somewhat better but the breast is very red and hot and the nipple kills during the feeding and after baby nurses.  Breast more painful after nursing.  Doctor told her that because the breast is red she has an infection that requires antibiotics.  She is not running a fever.  She is reluctant to take the antibiotics because of the possibility of thrush.  

My question is:  What is the research on the use of antibiotics vs. tincture of time, rest, fluids, extra nursing and warm compresses to treat mastitis?  How long can she generally allow her breast to remain this inflamed before it's prudent to start antibiotics.  And, if she does take antibiotics, do you all recommend concurrent use of acidophillus, and if so, what dosage?  


Thanks in advance,

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Julie, LLLL in NJ