From Jack Newman MD re: the mom with recurrent mastitis:

"I think it would be a pity to wean the baby. In the first place, since the
mastitis seems to occur only on the right (unless I missed something), if
worse got to worst, and nothing seems to be working, why not stop only on
the right side? Especially as the baby will soon be able to eat solids,
feeding one side should not be a burden. But there are other things to try
first.
The first thing here I think is to get the nipple fixed. It is quite likely
that the cracked nipple (which is also causing her pain), is the entry
point of bacteria (though I doubt GBS is a cause of mastitis, I guess
anything is possible). I would use the all purpose nipple ointment again.
Note that the recipe I use has changed. So if the mother is using the all
purpose nipple ointment as it's written in my book, the change may help. I
would also use other treatments for candida. Gentian violet, and grapefruit
seed extract (see the protocol, at www.breastfeedingonline.com, or ask me
for it,[log in to unmask]).

In treating a number of cases of candida, who coincidentally also had
recurrent blocked ducts (the presence of fever with a hard painful area in
the breast does not necessarily mean it's mastitis, if, by that, we mean
something caused by bacteria, rather than a fungus or virus or whatever), I
have found that the recurrent painful lumps disappeared with treatment of
candida. So I would work to do that now. In addition to treating the sore
nipples as above, perhaps grapefruit seed extract orally, and perhaps even
fluconazole for two weeks or more would be indicated.
Finally, some people believe that in these situations there is an
unresolved "subclinical mastitis" which flares up from time to time. I have
my doubts that there is such a thing as subclinical mastitis, but if the
aggressive treatment of the nipples and the treatment of candida orally
(with grapefruit seed extract and fluconazole) does not work, perhaps long
term antibiotics (for a month at least, probably cephalexin) could be tried.
So weaning is the last resort, and even then it can be only on one side,
the affected side. Are physicians not aware that a mother can dry up on one
side only?
Jack Newman, MD, FRCPC

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