Hello to all.  Boy, this is my week to have weird and scary cases.  I saw a
G2P2 mom today with bilateral mastitis.  Baby is 6 wk pp.  First incidence
of mastitis at two weeks pp in left breast.  Treated with antibiotics for 10
days; breast stayed inflamed for a week even on meds.  Both nipples have
been cracked and rather pus-y since early pp. Yeast around that time.  Baby
treated with Nystatin, mom told to paint nipples with baby;s meds.  Mom is
Group B strep carrier.  Current episode began 3 days ago. Ceftin (which is a
cephlasporin, I think) was phoned in same day. This time both breasts
affected.  Both appear scalded, and have stayed red even tho mom has been
faithfully taking meds.  I observed Peu d'orange  on left due to edema.
Neither breast would pump, even after application cold packs.  Mom taking
ibuprofen. Dr. has not seen the mom -- Nurse Practicioner saw her today.
Baby was very fitful when I saw them late today.  Struggled at breast and
would not nurse well (maybe milk tastes bad, maybe baby ill).  Baby not
febrile, but was still fussy sev. hrs later when I called.

So you tell me if I am over-reacting?  I told her I was concerned that
bilateral mastitis could be a strep infection.  I mentioned (without getting
specific) that I would not recommend continued nursing until pedi cultures
child's throat and says baby is ok.  I also suggested she insist on MD
seeing her.  Also to treat nipples topically, and do drug sensitivity to
make sure of right meds.

I have never seen bilateral mastitis once engorgement phase is over.  Any
one have any ideas?
Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html