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Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 3 May 2006 12:40:54 -0400
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Mary Kay Smith, RN, IBCLC wrote:
"I wonder if the "Big Guns" need to be used. I'm no pharmacist but aren't
vancomycin and other "heavy" antibiotics available orally?" 

-------------------------------

I'm just jumping in here to say that there is a very common misconception
that vancomycin is a "big gun" and is somehow stronger or better than other
antibiotics for the treatment of a typical mastitis.  

Vancomycin *is* better at treating *certain* types of bacteria that are
*resistant* to the more traditional antibiotics.  As most are aware, Staph
aureus is one of the most common bacteria implicated in mastitis and is
usually treated well with dicloxicillin (which is in a special subclass of
the penicillin family of antibiotics).  However, in certain cases, this
organism can be *resistant to* (not readily treated by) the anti-biotics in
this subclass.  In that case, the organism is typically called Methicillin
resistant Staph aureus (MRSA) and we need to resort to vancomycin (a
glycopeptide antibiotic) because there is no other good option.

*However* this should not be taken as evidence that Vancomycin is a
particularly "strong" or "big gun" antibiotic.  To the contrary, vancomycin
does not penetrate tissues in the body nearly as well as the other
antibiotics that we typically use to treat mastitis.  All things being
equal, if we are dealing with a typical organism (methicillin *sensitive*
staph aureus)- the more traditional antibiotics should work *better* than
the vancomycin.

Additionally- the more we use vancomycin, the higher the risk we have of
developing organisms that are resistant to *this* antibiotic too. 
Unfortunately, there are already cases of Vancomycin-Resistant Staph Aureus
(VRSA) out there.  

Certainly there are legitimate times to use vancomycin for mastitis- most
notably when we have a documented culture showing the presence of MRSA in a
patient.  However, it is important to keep in mind that the unnecessary use
of vancomycin increases the likelihood that we will someday be dealing with
many cases of difficult to treat vancomycin resistant infections in the
future.

As far as the oral form of vancomycin-- yes, there is an oral form of the
medication available.  However- its absorption through the GI system is
horrible, and it is therefore only effective when treating an infection in
the bowel itself.  It would not be at all effective in treating mastitis
because it would never make it out of the bowel and get to the breast.  

As a side note, the fact that vancomycin is so poorly absorbed through the
bowel is usually a good thing for breastfeeding moms.  When vancomycin is
given to the mom through an IV, even the small amounts getting into the
breastmilk won't be absorbed by the GI system of the babe!  (Hence the L1
designation by Hale.) :-)

Just trying to clear up some common misconceptions.  Sorry this was a bit
long-winded.

Jayne

Jayne R. Charlamb, MD, IBCLC
Breast Care Center
SUNY Upstate Medical University
Syracuse, New York







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