Prophylactic antibiotics for the prevention of postpartum infectious morbidity in women infected with human immunodeficiency virus: a randomized controlled trial. The treatment of Staphyloccocus aureus infected sore nipples: a randomized comparative study. Effect of intervention to improve breastfeeding technique on the frequency of exclusive breastfeeding and lactation-related problems. Induction of anti-secretory factor in human milk may prevent mastitis.
The purpose of this study was to determine the effect of intrapartum prophylactic antibiotics in the prevention of postpartum sepsis in laboring women who were infected with HIV.
                In a double-blind, randomized trial that was conducted in Durban (South Africa), pregnant women who were infected with HIV in whom vaginal delivery was anticipated were randomized to receive either a single dose of cefoxitin (2 g) or placebo intrapartum. Signs of sepsis were evaluated within 72 hours and at 1 and 2 weeks postpartum.
                Of the 424 women who were enrolled, 213 women received cefoxitin, and 211 women received placebo. Both groups were comparable in all baseline parameters. The overall sepsis rate was 19% (40/211 women) in the placebo group and 16.9% (36/213 women) in the cefoxitin group (P = .581). There was a 53% reduction in risk of postpartum endometritis in the cefoxitin group (95% confidence interval, 0.24-0.9).
                The use of prophylactic intrapartum cefoxitin in HIV-infected women reduces the risk of postpartum endometritis. 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. This randomized clinical trial compared frequencies of exclusive breastfeeding and lactation-related problems during the first 30 days among 74 mothers who received a 30-minute counseling session on breastfeeding technique in the maternity ward, and 137 controls. The frequency of exclusive breastfeeding among mothers who had received intervention was similar to controls by 7 days (79.7% vs 82.5%, respectively) and 30 days (60.8% vs 53.3%). There was no difference between groups in the frequency of sore nipples at 7 and 30 days, in breast engorgement and mastitis, and in the quality of breastfeeding technique at 30 days. Therefore, a single intervention at maternity was not sufficient to improve breastfeeding technique, increase exclusive breastfeeding rates, and reduce the incidence of breastfeeding problems during the first month. The aim of the study was to try to induce anti-secretory factor (AF) in human milk and possibly prevent mastitis.
                Forty mothers who had normal deliveries and healthy full-term infants were randomly divided into two groups, 3-7 days postpartum. The experimental group received a food inducing AF. The control group received the same type of food, without AF-inducing properties. Milk was tested for AF after the mothers had eaten the cereals for 4-5 wk. AF was determined by intravenous injection of milk samples into rats measuring their capacity to prevent secretion into a gut loop of the rat injected with cholera toxin.
                The median levels of AF differed between the experimental (n = 12) and control groups (n = 16): 1.1 (0.7-1.25) units vs 0.1 (0.0-0.25) units, Z = -4.492, p < 0.0001 (11 mothers dropped out and one milk sample is missing from one of the control mothers). The frequency of mastitis in the experimental compared with the control group was reduced (p = 0.0086, permutation test). The median AF levels in mothers with or without mastitis differed; 0.0 (0.0-0.1) vs 0.5 (0.2-1.1), Z = -2.399, p = 0.017.
                We suggest a specially treated cereal induces AF in human milk and protects against clinically manifested mastitis.
There was insufficient evidence to show effectiveness of any of the interventions, including breastfeeding education, pharmacological treatments and alternative therapies, regarding the occurrence of mastitis or breastfeeding exclusivity and duration. While studies reported the incidence of mastitis, they all used different interventions. Caution needs to be applied when considering the findings of this review as the conclusion is based on studies, often with small sample sizes. An urgent need for further adequately powered research is needed into this area to conclusively determine the effectiveness of these interventions.