Molly
Thanks for alerting us to the Cochrane Review on Antibiotics for
mastitis in lactating women. I just looked up the link you sent and
found this plain language summary, which seems somewhat clearer than
the abstract:
Plain language summary: Antibiotics for mastitis in breastfeeding women
Inflammation of breast or mastitis could be infective or
non-infective. Infective mastitis is one of the most common
infections experienced by breastfeeding women. The condition
(infective or not) varies in severity, ranging from mild symptoms
with some local inflammation, redness, warmth and tenderness in the
affected breast through to more serious symptoms including fever,
abscess and septicemia, which may require hospitalization. Recovery
can take time, and there may be substantial discomfort for the
affected mother and her baby. Mastitis usually occurs during the
first three months after birth and result in the mother being
confined to bed for one day, followed by restricted activity. The
condition is associated with decreased milk secretion, decreased
productivity, and in difficulties caring for the baby. This burden to
mothers, along with the cost of care, the potential negative impact
on continuation of breastfeeding, and the danger of serious
complications such as septicemia, makes mastitis a serious condition
which warrants early diagnosis and effective therapy. The review
included two studies and approximately 125 women. One study compared
two different antibiotics, and there were no differences between the
two antibiotics for symptom relief. A second study comparing no
treatment, breast emptying, and antibiotic therapy, with breast
emptying suggested more rapid symptom relief with antibiotics. There
is very little evidence on the effectiveness of antibiotic therapy,
and more research is needed.
[Me again] This review included only two studies of only
approximately 125 women. That's not nearly enough, IMHO, to say that
there is little evidence on the effectiveness of antibiotic therapy
..... and yet this inconclusive expert opinion will be enshrined
forever in a Cochrane Review to guide future practice.
I know that we set great store by Cochrane Reviews. But speaking
entirely personally, I'm coming to the conclusion that some of them
are not terribly helpful. I think it's the rather "selective" way
that their so-called selection criteria are determined. When you
think about it, anyone could skew the results of almost any review
article by deciding in advance what to include and what to
exclude. The insistence on relying solely on randomised controlled
trials misses the extremely useful observational trials that have
been done, leaving out some really crucial research. I'm also
becoming concerned about planned randomised controlled trials - when
certain drug therapies are already known to combat certain infections
- and the implications of withholding therapy from mothers and babies
in the placebo arms. Why do this? Just so that randomisation can be
achieved to subsequently "prove" that something already tried and
tested to work really does so??
This little review will not alter my experience and observation of
working with mothers who get mastitis which has shown me that if you
catch engorgement and plugged ducts early enough (within 24 hours of
the first Sx) and resolve them very promptly with frequent and
thorough breast drainage, then mastitis should be almost entirely
preventable without the use of antibiotics. But if these conditions
are left - and the longer they're left the higher the risk - then
treatment with an appropriate antibiotic (and you can culture the
milk to find out what that is) _and_ continued thorough breast
drainage can almost always prevent mastitis progressing to
abscess. On the other hand, when mothers don't know what to do and
when doctors delay prescribing, then the risks of lactation failure
and abscess, with much pain/suffering and disastrous consequences to
everyone - are high. Consequently, my mastitis care plan would
include daily face to face follow-ups until it can be _seen_ that any
fever, pain/tenderness, inflammation and induration are resolving,
and prompt medical referral for advice about antibiotic therapy, or
repeat therapy, until I know it's quite over - irrespective of some
little Cochrane Review of 125 subjects!
Pamela Morrison IBCLC
Rustington, England
-------------------------------------
Date: Mon, 15 Feb 2010 09:22:23 -0800
From: Molly Brannigan <[log in to unmask]>
Subject: Mastitis - Evidence for Antibiotics?
Hello All-
Speaking of evidence-based practice, has anyone read this Cochrane review
which suggests that their is insufficient evidence for the efficacy of
antibiotics for mastitis!?
Cochrane Database Syst
Rev.<javascript:AL_get(this,%20'jour',%20'Cochrane%20Database%20Syst%20Rev.');>
2009
Jan 21;(1):CD005458.
Antibiotics for mastitis in breastfeeding women.
Jahanfar
S<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Jahanfar%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>
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