Nipple damage often becomes infected. The risk of infection is highest during the first week after delivery and is more likely to be present with deeper damage.
Mothers at higher risk of infection or those that have signs of an early or mild infection may consider antibiotic or antibacterial products. Oral antibiotics (those taken by mouth) are more powerful than products that are put on the skin and may be required for more severe infections.
1) Antibiotic ointment
If you are at high risk of a bacterial infection from your nipple damage or have early signs of one, you and your health-care provider may consider short-term use of a prescription ointment containing an antibiotic to kill dangerous bacteria. Mupirocin and fusidic acid are effective for common skin infections and are reasonable options (CADTH 2017; Stevens 2014).
Antibiotic ointments often contain petrolatum, or petroleum jelly. As an alternative, a pharmacist can combine mupirocin powder and purified lanolin. Antibiotic creams should be avoided as they may delay healing.
To prevent the baby from swallowing any ointment:
- Use minimal amounts.
- Only apply it to the damaged area.
- Before the baby breastfeeds, gently clean the area with breast milk and a soft, clean cloth.
Breast milk will not harm the damaged area and contains a little fat to help clean greasy ointments.
Antibiotic ointments are applied to the skin with a cotton swab or a clean finger.
2) Medical grade honey
Medical grade honey, which has been treated to remove the bacteria that cause botulism, can be used to prevent and treat infection by slowing the growth of bacteria. It also encourages healing by stimulating the growth of granulation tissue (Norman 2017).
Medihoney® is one brand of medical grade honey and can be applied by pad or as a thick liquid. The former is more expensive.
Liquid medical grade honey can sting when applied. To minimize this, you can use it occasionally and use purified lanolin the rest of the time. It can also crystallized and the sharp crystals may cause pain. To melt the crystals, wash your hands thoroughly and rub a small amount of the honey between your index (pointer) finger and thumb until the crystals have dissolved.
Medical grade honey does not need to be washed off.
3) Combination ointments
We have found combinations of steroids, antibiotics, and antifungal agents (combination ointments; all-purpose nipple ointment [APNO]) helpful for small, infected, late-onset wounds that do not respond to moist-wound healing combined with antibiotic or antibacterial preparations. This has allowed us to avoid the use of stronger antibiotics by mouth. However, there are concerns with using these.