When S. aureus infection is suspected, the topical use
of mupirocin at 2% or even systemic antibiotic therapy is
recommended.A study showed that systemic antibiotic
therapy (dicloxacillin) was highly efficient in the treatment
of nipple infection caused by S. aureus, compared to other
treatment schemes: guidance to improve the breastfeeding
technique, topical mupirocin and topical fusidic acid. The
treatment was better in terms of regression of symptoms
and also prevented the development of mastitis: 25% of
mothers with nipple infection caused by S. aureus not
treated with systemic antibiotics developed mastitis
whereas only 5% of treated mothers had the disease.
Neifert recommends that the risks and benefits of systemic
antibiotic therapy be weighed in relation to early weaning
due to persistent nipple pain and to the morbidity
associated with puerperal mastitis.