When I work with a mother with recurrent mastitis I usually have the whole
family cultured for staph and strep infections. Usually one of the other
children or the woman's partner is an asymptomatic carrier.

Throat and nasopharengheal (sp?) cultures are taken and then the affected
person is treated. Prophylactic antibiotics may become useless if the
mother is repeatedly exposed to the pathogen and resistance will build up.

Last year I worked with a mother who had 7 or 8 bouts of mastitis. Her doc
was very reluctant to culture the family and (of course) advised her to
wean. She had been on prophylactics but (as usual) had quite a few break
through infections and we were running out of antibiotics to use on her.
Finally the doctor consented to culture the family and the mother's husband
grew out naso-pharengheal staph. He was treated with oral and nasal drop
antibiotics (along with a "no intimate contact" order for the duration of
his treatment) and the mother has been free of mastitis for over a year.

In one family I worked with the carrier was the dog! (I am NOT kidding.)
Dogs often carry strep and pass it on to family members.

Finding a carrier and treating him (or her)(If this is the origin of the
pathogen) is preferable to the side effects and failures that many of us
see with prophylactic antibiotics.

Mary Jozwiak IBCLC, LLLL, AAPL
Private Practice

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