Helen wrote, "Have you thought about not using antibiotics and have the
mother take NSAID Ibuprofen instead, given that there is Infectious mastitis
and Non-infectious mastitis and that at least 50% of lactating women with
mastitis do not have an infectious condition?

"We forget that antibiotics have another very important role and that is they
are very effective anti-inflammatories.  We can easily jump to the conclusion
that there was an infection present because the antibiotic cleared up the
symptoms quickly, when in reality, no such thing was there,  just unrelieved
distension where the milk is forced back through the cell walls and out into
the tissue/capilliaries and our immune system kicks in, making a fuss about
the milk swimming about where it shouldn't be.    A non steroidal anti-
inflammatory such as Ibuprofen has a more than excellent chance of doing the
trick along with adequate milking/draining of the breast."

I knew my care plan involving antibiotic use would press some buttons!  You
are quite right of course.  However, I do think that breasts that have
undergone reduction surgery, with the real risk of severed ducts/inability
to drain may be more likely to become infected as a result of milk stasis.
If the milk cannot drain - ever - would there not be an increased risk of
actual infection (and we could not culture the milk to see whether this was
infective or non-infective mastitis anyway, could we - or could we? would it
leak into surrounding ducts which *were* draining??)  My humble opinion is
that the use of antibiotics in these very special cases would be justified.

There is one doctor here in my experience (only one!) who will not prescribe
an antibiotic in cases of mastitis, and does prefer ibuprofen.  My
observation is that the mastitis takes considerably longer to start
resolving to the point that you know the mom is going to be OK - about five
days, instead of the two that I have come to expect.  Personally I find this
*extremely* nerve-racking!
Breast abscess is the pits, and IMO should be completely preventable - but
it needs to be jumped on promptly.  I have asked a lot of the doctors about
this - e g how they like to treat mastitis, do they want me to send their
patients in to them promptly if I see it first?  They get this look of
horror on their faces, some describe incising and draining breast abscesses
during their training in "the rural areas" (Jack will no doubt know about
this) and answer that they usually prescribe an antibiotic straight away,
because the risk of abscess is just not worth it.  I confess I tend to agree.

However, that being said, if the mom is draining the breast frequently and
well, and resting, sometimes the symptoms resolve by the next day - I
conclude then that it was not the antibiotic which effected the cure, so
that it probably was not needed.  Nevertheless personally I dread the
possibility of abscess so I will urge/nag the mom to see her doctor within
24 hours if frequent and efficient drainage does not result in a
*significant* reduction of symptoms - fever (not always present) pain,
inflammation and lumpy areas.  Moms who had undergone previous breast
surgery would receive the same protocol.

Just my .O2. Sorry so long. I would welcome others' thoughts.

Pamela Morrison IBCLC, Zimbabwe