Julie
When to start antibiotics is really a judgement call. Some would start
antibiotics right away if the initial presentation of mastitis is pretty
severe, such as fever, headache, body aches, and 'angry' breast. If the
mom's symptoms/signs are not severe, most would try the 'usual
comfort/treastment measures' and if not resolved or nearly resolved in 24
hrs, then start antibiotics. Some docs give the prescription but tell the
client not to fill it yet and see if the usual measures work in 24 hrs, if
not fill the prescription.
Your client's s/s sound pretty bad to me. ("but the breast is very red and
hot and the nipple kills...)". Many moms do not present w/ fever. The WHO
publication (mine is at work) mentioned recently is in the archives and is
an excellent discussion of this type of decision making process.


Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA




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