Thank-you Catherine for your answer.

The study that informs the suggestion to use antibacterial ointment on cracked or fissured nipples is referenced on page 262 of Breastfeeding and Human Lactation-2010.  "If the skin is broken, consider applying a thin coating of topical antibiotic to prevent infection with S. aureus.  (Livingstone and Stringer 1999)"  The study was presented in the Journal of Human Lactation in 1999 Livingstone V, Stringer LJ.  The treatment of Staphyloccocus aureus infected sore nipples: a randomized comparative study.

The study concluded that it was much more effective for healing and prevention of mastitis to take oral antibiotics than topical antibiotics if nipples were already infected.  It also determined that "Mothers with infants younger than 1 month who complain of moderate to severe nipple pain with cracks, fissures, ulcers or exudates have a 54% chance of having S. aureus colonization.2"  I think the idea is to avoid the infection by using the topical antibiotics so that oral antibiotics will not be needed and in order to keep the S. aureus from slowing healing.

It looks like I overstated when I wrote that the topical antibiotics are needed.  The book just mentions to consider them.

Laura Spitzfaden LLLL, IBCLC

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