This woman with chronic breast pain, tenderness, plugs and reduced
supply likely has an intraductal bacterial infection. Some people call
this a subacute mastitis.
My hypothesis is that this is caused by an overgrowth of coag neg staph,
a bacteria that normally inhabits the lactating breast. (A good
analogy is bacterial vaginosis.)
Overgrowth causes plugs and deep pain. Bacterial DNA is very sticky, and
I believe is the reason for the plugging.
I find a great deal of success in treating these cases as bacterial
infections, by doing a breast milk culture, asking for sensitivities of
the coag neg staph ( a bacteria labs often consider as a contaminant),
and treating based on sensitivities. Most coag neg staph is resistant to
oxacillin. Sulfa, clinda, erythro often can work well, depending on
sensitivities.
I usually treat until sx are gone, minimally 6 weeks for most women.
They usually notice a 30% improvement in the first 2 weeks, then rapidly
improve after that, as long as they are responding well to the antibiotic.
I don't use galactogogues until the plugging is gone, since they will
increase engorgement if plugging is not controlled.
Milk supply should gradually increase as the infection improves.
I have been also using some homeopathics to try to prevent recurrence,
and to try to push women towards a more speedy recovery.
Anne
Anne Eglash MD, FABM, IBCLC
Clinical Professor
Dept of Family Medicine
University of Wisconsin School of Medicine and Public Health
600 N. 8th St.
Mount Horeb, WI, 53572
608-437-3064 (O)
608-437-4542 (fax)
608-550-3054 (pager)
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