Beth has asked for a reference on non-healing nipple cracks. Bacteria have the ability to grow in colonies and protect the colony with a coating called a biofilm. Biofilms may potentially be stimulated by salvia as when a baby feeds at the breast. In order to disrupt this protective biofilm, washing the nipple wound with soap and water once a day followed by a coating of mupirocin may penetrate the biofilm, promote wound healing, and prevent progression to an infection (Ryan, 2007). If careful washing of the cracked nipples and 2% mupirocin ointment does not help heal the cracks after proper position, latch, and tongue-tie have been reviewed, this mother may need systemic antibiotics. As the nipples have not been cultured, it is not possible to know the offending organism but 10 days of dicloxacillin, cephalosporin or erythromycin have been recommended in the following article:

Livingstone V, Stringer LJ. The treatment of Staphyloccocus aureus infected sore nipples: a randomized comparative study. J Hum Lact 1999; 15:241-246.

Ryan TJ. Infection following soft tissue injury: its role in wound healing. Curr Opin Infect Dis. 2007;20:124-128.

Small colony variants (SCVs) of Staphylococci cause low grade, persistent, antibiotic resistant, chronic, and recurrent infections that take many weeks of antibiotics to clear. 

Perhaps if the nipple cracks were cultured and the offending organisms identified, systemic antibiotics may be of help.

Marsha Walker, RN, IBCLC
Weston, MA


             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome