An Update on the Recognition and Management of Lactational Breast Inflammation

Christine M. Betzold, NP, CLC, MSN


J Midwifery Womens Health. 2007;52(6):595-605. 

In This Article

Infections of the Nipple

When there is a disruption in nipple/areolar skin integrity, often as a result of mechanical trauma from imperfect nursing, it may lead to secondary infection. Infection should be suspected when nipple sores or soreness persists or does not improve after a couple of days. Again, S aureus is the primary pathogen, especially if yellow exudates are present. However, C albicans may be the primary organism, or there may even be a mixed infection that is both candidal and bacterial. Regrettably, it is almost impossible to discern by physical exam alone whether the sores are caused by mechanical, bacterial, fungal, or a mixed infection.

Treatment options for suspected bacterial infections include topical or oral antibiotics. One researcher recommends using oral antibiotics in women with skin breakdown, because many of her subjects developed infectious mastitis when their use was delayed.[19] However, when nipple infection is not accompanied by skin breakdown, systemic symptoms, or deep breast pain, topical preparations are the first-line choice. Topical preparations can be used in conjunction with oral antibiotics. In terms of treatment, while mupirocin is generally used for suspected bacterial infections, newer information reveals that mupirocin may also treat yeast,[36,37] although it is not suggested to use it alone.

When nipple candidiasis is diagnosed, mother and infant must both be treated simultaneously, and it is important to cleanse all things coming in contact with the milk, the infant's mouth, or the mother's breasts.[35] It may be prudent to discourage the use of pacifiers given their association with C albicans colonization.[33,35] If pacifiers must be used, replace and/or sterilize the pacifiers frequently. Finally, attention to maintaining a well balanced diet should be encouraged.[35] When creams are prescribed (for bacterial or antifungal conditions), rinsing or washing of the nipples is unnecessary, especially if applied sparingly after a feeding/pumping and if the medication is not visible when the infant begins to nurse.[17] See Table 3 for other treatment options.


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