From Catherine Watson Genna, IBCLC, here is the start of our second discussion for Journal Club. Please feel free to jump in and start the discussion of this article, and feel free to bring in the companion article by Lisa Amir MD, et al, as well, from the same JHL issue. Kathleen "The Treatment of Staphyloccocus Aureus Infected Sore Nipples: A Randomized Comparative Study." by Verity Livingtone, MBBS, FCFP, IBCLC and L. Judy Stringer, MBBS, MRCGP, IBCLC, Journal of Human Lactation, 15(3), 1999. The authors suspected a link between delayed healing of cracked nipples and Staph aureus infection. Women presenting with cracked nipples, but without mastitis, had their nipple lesions cultured. Those positive for Staph aureus were randomized to one of four treatment groups: - individualized bf technique assistance from an LC. - topical mupiricin ointment (Bactroban) and bf technique assistance. - topical fusidic acid ointment and bf technique assistance. - beta lactamase resistant systemic antibiotics (dicloxacillin or erythromycin 500mg/qid/10d) and bf technique assistance. Women were re-evaluated in 7 days, and nipples assessed as better/resolved, no change, and worse based on pain and skin appearance. Any cellulitis, mastitis, or fever was considered a treatment failure, and oral antibiotics were prescribed. Results: a large proportion of each of the non-systemic treatments failed to improve, and a significant proportion progressed to mastitis. 79% of women in the oral antibiotic group improved and only 5% worsened. Fusidic acid outperformed mupiricin, but only a minority of women were improved in one week with both topical treatments. Optimal technique alone showed improvement in only 9% of women in this study, 35% of them worsened over one week, and 30% progressed to mastitis. In all, 25% of mothers treated non-systemically progressed to mastitis, but only 5% of those given oral antibiotics developed mastitis. The authors recommend that sore, cracked nipples be clinically diagnosed as impetigo vulgaris, and be treated with systemic antibiotics for a minimum of 10 days until the skin is fully healed, while improving breastfeeding technique to prevent added trauma or friction to the nippples. Other interesting points: - 5 women in this study reported deep, radiating, burning breast pain and episodic vasospasm of the nipples, unrelated to immediate sucking. The authors attribute this to both repetitive gumming of the nipple and the S. aureus infection. - The advice to not use soap on the nipples contradicts hygeinic adjuncts to impetigo treatment. - 17% of the moms with S. aureus infections had poorly graspable nipples. - 10% of their infants had tongue tie, and 12% had significant retrognathia. -- Catherine Watson Genna, IBCLC New York City mailto:[log in to unmask] *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html