Help: My client presents with a generalised mastitis in one breast with inflammation beginning at the nipple (which is damaged)and radiating up to involve half of the breast. The top half of the breast looks and feels normal. The inflammed half is tender and swollen right around. She has had no fever throughout. We treated the initial stages conservatively by frequent feeding, panadol 4hrly, rest and plenty of fluids. I was phoned 3 days later to say the inflammation was the same. Flucloxacillin 500mgs 6hrly was commenced with no change after 48hrs. She visited her doctor who took a swab from her weeping caesarian section wound, her nipple and her baby's weeping eye. He started her on augmentin. The wound swab grew staphylococcus aureus, the nipple site was clear but the baby's eye swab grew chlamydia. With no effect from the flucloxacillin and augmentin we wondered if the chlamydia infection had entered the breast via the damaged nipple so she was commenced on erythromycin. This also has made no difference to the inflammation so I am at a loss for what to recommend. The breast has now remained inflammed and tender, getting no better and no worse for nearly 4 weeks. The doctor has suggested a stronger antibiotic for which she would have to stop breastfeeding She is not keen to do this. I would be grateful for any suggestions as to what is causing this unusual pattern of mastitis and what can be done about it. Thanks. Robyn Dunning, NZRN, NZRM, IBCLC D.Bruce Dunning Statistics Department Massey University