title: Role of oral antibiotics in treatment of breastfeeding women with chronic breast pain who fail conservative therapy.
abstract: BACKGROUND
  Although breast pain remains a common cause of weaning, controversy exists regarding the etiology of chronic pain. Prospective studies are needed to define optimal treatment regimens. We evaluated patient history, exam, and bacterial cultures in breastfeeding women with chronic breast pain. We compared pain resolution and breastfeeding complications in patients responding to conservative therapy (CTX) (n=38) versus those in patients failing CTX and receiving oral antibiotic treatment (OTX) (n=48).
  
  
  METHODS
  We prospectively enrolled 86 breastfeeding women with breast pain lasting greater than 1 week and followed up patients through 12 weeks.
  
  
  RESULTS
  Higher initial breast (p=0.012) and nipple pain severity (p=0.004), less response to latch correction (p=0.015) at baseline visit, and breastmilk Staphylococcus aureus growth (p=0.001) were associated with failing CTX. Pain type was not associated with failure of CTX. When culture results were available at 5 days, breast pain remained higher (p<0.001) in patients failing CTX and starting antibiotics. OTX patients then had more rapid breast pain reduction between 5 and 14 days (score of 3.1 vs. 1.3; p<0.001). By 4 weeks there was no difference (1.8/10 vs. 1.4/10; p=0.088) in breast pain level between groups. Median length of OTX was 14 days. At 12 weeks, weaning frequency (17% vs. 8%; p=0.331) was not statistically different.
  
  
  CONCLUSIONS
  Initial pain severity and limited improvement to latch correction predicts failure of CTX. S. aureus growth is more common in women failing CTX. For those women not responding to CTX, OTX matched to breastmilk culture may significantly decrease their pain and is not associated with increased complications.
authors.affiliation: 1 Department of Family Medicine, Case Western Reserve University , Cleveland, Ohio.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Witt
authors.forename: Kelly
authors.initials: K
authors.lastname: Burgess
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Hawn
authors.forename: Steven
authors.initials: S
authors.lastname: Zyzanski
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001941:Breast Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000523:psychology; D001942:Breast Feeding / Q000009:adverse effects* / Q000523:psychology; D002179:Candidiasis, Cutaneous / Q000188:drug therapy / Q000382:microbiology* / Q000523:psychology; D059350:Chronic Pain / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D015169:Colony Count, Microbial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008895:Milk, Human / Q000382:microbiology; D009558:Nipples / Q000382:microbiology; D009820:Ohio; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D014886:Weaning
chemical_list: D000900:Anti-Bacterial Agents