title: The treatment of Staphyloccocus aureus infected sore nipples: a randomized comparative study.
abstract: Sore, cracked nipples are commonly experienced by breastfeeding mothers. We have previously reported a strong correlation between sore, cracked nipples and S. aureus colonization. A prospective, randomized clinical trial was performed to compare four treatment regimes for S. aureus infected sore nipples. Eighty-four breastfeeding mothers were enrolled in the study. After 5 days to 7 days of treatment, only 8% of mothers showed improvement in the "optimal breastfeeding technique alone" group, 16% improved with topical mupiricin, 29% improved with topical fusidic acid, yet 79% improved with oral antibiotics (p < .0001). Optimal breastfeeding techniques and topical antibiotics ointment failed to heal most infected, sore, cracked nipples. Mastitis developed in 12% to 35% of mothers not treated with systemic antibiotics compared to 5% of mothers treated with systemic antibiotics (p < .005). In conclusion, S. aureus infected sore, cracked nipples should be diagnosed as a potentially widespread impetigo vulgaris and treated aggressively with systemic antibiotics in order to improve healing and decrease the risk of developing mastitis due to an ascending lactiferous duct bacterial infection.
authors.affiliation: Vancouver (Canada) Breastfeeding Centre, BC, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Livingstone
authors.forename: L J
authors.initials: LJ
authors.lastname: Stringer
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001941:Breast Diseases / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D005672:Fusidic Acid / Q000627:therapeutic use*; D006801:Humans; D016712:Mupirocin / Q000627:therapeutic use*; D009558:Nipples / Q000382:microbiology*; D010146:Pain / Q000382:microbiology*; D011446:Prospective Studies; D013207:Staphylococcal Skin Infections / Q000188:drug therapy* / Q000382:microbiology*; D013211:Staphylococcus aureus
chemical_list: D000900:Anti-Bacterial Agents; D005672:Fusidic Acid; D016712:Mupirocin