I'm working with a mother with a significant oversupply, especially in the
right breast. She has had a plugged area in that breast since before I first
saw her on pp day 7; now 9 days later she reports it is still there and
getting worse despite frequent feeding, some pumping (trying to minimize d/t
oversupply), massage, cabbage/cool compresses, lecithin. She is trying
castor oil packs today. She has been taking sage (1/4 t 3x/day) for two days
to try to help manage the oversupply, and feeding only one breast per feed
(not going longer right now d/t plugs).

She called her OB today and, due to mom's allergy to penicillin, prescribed
erythromycin, 250mg, 4x/day for 7 days. Hale classifies this as L2 but
states there is research associating it with pyloric stenosis in newborns.
Both Lawrence and Riordan suggest cephalexin or other cephalosporins in case
of penicillin allergy for treating mastitis.

Mother reports last time she took abx (pre-baby) she got thrush in her
mouth, so she is also taking acidopholus, and OB also prescribed nystatin
ointment for her to use prophylactically on her nipples.

I also suggested mom might contact her OB about a breast ultrasound
(concerned there might be an abcess). Mom reports no fever or other symptoms
of mastitis, but she has also been taking ibuprofen daily since birth for
pain.

Any input? If erythromycin may not be the most appropriate abx for this mom,
how do you suggest I communicate with the OB?

Thanks!

Lisa Mandell, MBA, IBCLC
Havertown, PA
www.best4both.com

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