{
  "schema_version": 1,
  "kind": "condition",
  "id": "nipple-symptoms",
  "name": "Nipple Symptoms",
  "category": "acute",
  "sources": "Egyptian National Drug Formulary - antimicrobial-2023.pdf, Miconazole monograph (chapter PDF p407) · Egyptian National Drug Formulary - antimicrobial-2023.pdf, Mupirocin monograph (chapter PDF p409) · World Health Organization. Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: WHO; 2009. Session 7, 'Management of breast conditions and other breastfeeding difficulties', sections 7.4 (Mastitis) and 7.8 (Candida infection (thrush) in mother and baby).",
  "review_status": "reviewed",
  "verified_against": "Egyptian National Drug Formulary - antimicrobial-2023.pdf, Mupirocin monograph (chapter PDF p409)",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 1220,
      "generic": "Mupirocin",
      "line": 2,
      "is_adjunct": false,
      "form": "topical",
      "strength_mg": null,
      "adult_dose": "Apply to the affected area 2 to 3 times daily",
      "adult_duration": "7 to 14 days, depending on severity; re-evaluate if no response after 3 to 5 days",
      "dose_source": "Egyptian National Drug Formulary - antimicrobial-2023.pdf, Mupirocin monograph (chapter PDF p409)",
      "rationale": "For a cracked or fissured nipple that becomes secondarily infected with Staphylococcus aureus or Streptococcus pyogenes, matching the formulary's 'secondarily infected traumatic skin lesion' indication.",
      "cautions": [
        "Only for localized lesions up to 10 cm/100 cm2 in area per formulary indication - larger or worsening infection needs a different approach.",
        "Avoid prolonged or repeated courses (risk of resistance).",
        "New nipple retraction/inversion, bloody discharge, or a persistent ulcer needs referral to exclude breast cancer.",
        "Generally considered compatible with breastfeeding, but wipe residual ointment before the next feed."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Infants, children, and adolescents: apply a small amount 3 times daily for 5 to 10 days; re-evaluate if no clinical response after 5 days.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "BACTROFORM 2% TOP. OINT. 15 GM",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA",
          "price_egp": 35.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 15000.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "MUPIROCIN SAJA 2% TOP. OINT. 15 GM",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "BIOPHARM EGYPT > SAJA PHARMA",
          "price_egp": 35.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 15000.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "MUPIRAX 2% OINT. 10 GM",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "GLOBAL NAPI PHARMACEUTICALS",
          "price_egp": 48.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 10000.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "MUPIROCIN SAJA 2% TOP. OINT. 20 GM",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "BIOPHARM EGYPT > SAJA PHARMA",
          "price_egp": 83.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 20000.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "MUPIRAX 2% OINT. 30 GM",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "GLOBAL NAPI PHARMACEUTICALS",
          "price_egp": 118.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": 30000.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "nipple-symptoms"
    }
  ]
}