From the Guidelines
Nipple infections, also known as mastitis, can be treated with a combination of antibiotics, pain management, and continued breastfeeding, with dicloxacillin or cephalexin 500mg four times daily for 10-14 days typically recommended for bacterial mastitis. The treatment of nipple infections should prioritize the use of antibiotics that are effective against streptococci and Staphylococcus aureus, as these are the most common causative pathogens 1. While taking antibiotics, it is essential to continue emptying the breast regularly through breastfeeding or pumping to prevent the accumulation of bacteria and promote healing. Applying warm compresses before feeding and taking ibuprofen 400-600mg every 6 hours as needed for pain and inflammation can also help alleviate symptoms. Ensuring proper latch if breastfeeding and considering seeing a lactation consultant can help prevent further complications.
For fungal infections (thrush), antifungal creams like clotrimazole or miconazole applied to the nipple after feedings for 7-14 days may be needed 1. It is crucial to seek medical attention if symptoms worsen after 48 hours of treatment, if a fever over 101°F develops, or if pus or red streaking from the nipple is noticed, as these may indicate a more serious infection requiring different treatment. The use of systemic corticosteroids as an adjunct to antibiotic therapy may be considered in selected adult patients to hasten resolution and reduce inflammation, as suggested by a randomized, double-blind, placebo-controlled trial 1.
In terms of prevention, measures to reduce recurrences of cellulitis include treating interdigital maceration, keeping the skin well hydrated with emollients, and reducing any underlying edema through elevation of the extremity, compressive stockings, or pneumatic pressure pumps 1. Prophylactic antibiotics may be considered if frequent infections occur despite these measures, with options including monthly intramuscular benzathine penicillin injections or oral therapy with erythromycin or penicillin V 1.
Key considerations in the treatment of nipple infections include:
- The use of antibiotics effective against streptococci and Staphylococcus aureus
- Continued breastfeeding and emptying of the breast to promote healing
- Pain management with ibuprofen and warm compresses
- Antifungal creams for fungal infections
- Seeking medical attention for worsening symptoms or signs of serious infection
- Preventive measures to reduce recurrences of cellulitis, such as treating interdigital maceration and reducing underlying edema.
From the Research
Nipple Infection Treatment
- Nipple candidiasis can cause burning, stinging pain radiating from the nipples into the breast, lasting throughout feedings and beyond 2.
- A study found that fluconazole reduced, but did not eliminate, the nipple yeast and accompanying pain in a breastfeeding mother with cracked nipples 2.
- The use of a topical yeast medication (tristatin ointment) for a total of 8 weeks on the nipples/areola, in combination with fluconazole, helped to resolve the overt pain 2.
Nipple Fissure and Nipple Pain
- Nipple fissure and nipple pain are common complaints among breastfeeding mothers 3.
- Mupirocin has been found to be effective in preventing and treating infections of damaged nipples and nipple pain 3.
- Acidic fibroblast growth factor (aFGF) plays an important role in wound healing, and a study is being conducted to test the hypothesis that mupirocin plus aFGF is more effective than mupirocin alone for nipple fissure and nipple pain in breastfeeding women 3.