<...  Lisa Amir's article in JHL talked about using pain rather than febrile
sx
per se as a better diagnostic indicator of mastitis for this very reason...>

Thanks for mentioning this article Barbara, but as it was an audit of
medical histories we can't hypothesize too much from this study. It may be
that some of the women diagnosed by the emergency dept doctors as "mastitis"
and treated with antibiotics, may have been classified as a noninfective
mastitis by other people. My definition of mastitis would be that women has
either a fever or flu-like symptoms (chills, rigours, headache, muscle
aches, nausea, etc). I have seen women with an abscess without a fever or
systemic symptoms, but I'm not sure I would treat a woman with antibiotics
if she has no fever and feels well.
I am about to start a new study of women with mastitis presenting to the
emergency department and the definition I'm using is that the woman must
have at least 2 out of breast pain, redness and lump, AND fever or systemic
symptoms. I'd welcome comments about this definition. Many studies have
included "mastitis diagnosed by medical practitioner" - which is not
adequate here as I am wanting the doctors/ midwives to use a consistent
definition.
I have been working with the Academy of Breastfeeding Medicine on a protocol
for mastitis - this is now completed. You may like to check out the website
as there are several new protocols ready for circulation (and feedback!).
http://www.bfmed.org/
Lisa Amir
MBBS, MMed, IBCLC in Melbourne, Australia

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