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Summary of quality assessment of included studies. Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
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Figure 1

Summary of quality assessment of included studies. Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
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Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

Comparison 1 Antibiotic versus no antibiotic, Outcome 1 Mastitis.
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Analysis 1.1

Comparison 1 Antibiotic versus no antibiotic, Outcome 1 Mastitis.

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 1 Mastitis.
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Analysis 2.1

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 1 Mastitis.

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 2 Sore nipples.
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Analysis 2.2

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 2 Sore nipples.

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 3 Breast engorgement.
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Analysis 2.3

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 3 Breast engorgement.

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 4 Exclusive breastfeeding.
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Analysis 2.4

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 4 Exclusive breastfeeding.

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 5 Breastfeeding problems, mean per mother.
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Analysis 2.5

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 5 Breastfeeding problems, mean per mother.

Comparison 3 Anti‐secretory factor in cereal versus standard cereal, Outcome 1 Mastitis.
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Analysis 3.1

Comparison 3 Anti‐secretory factor in cereal versus standard cereal, Outcome 1 Mastitis.

Comparison 3 Anti‐secretory factor in cereal versus standard cereal, Outcome 2 Mastitis recurrence.
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Analysis 3.2

Comparison 3 Anti‐secretory factor in cereal versus standard cereal, Outcome 2 Mastitis recurrence.

Comparison 4 Mupirocin ointment versus breastfeeding advice alone, Outcome 1 Mastitis.
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Analysis 4.1

Comparison 4 Mupirocin ointment versus breastfeeding advice alone, Outcome 1 Mastitis.

Comparison 5 Fusidic acid ointment versus breastfeeding advice alone, Outcome 1 Mastitis.
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Analysis 5.1

Comparison 5 Fusidic acid ointment versus breastfeeding advice alone, Outcome 1 Mastitis.

Comparison 6 Mupirocin ointment+BF advice versus fusidic acid ointment+BF advice, Outcome 1 Mastitis.
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Analysis 6.1

Comparison 6 Mupirocin ointment+BF advice versus fusidic acid ointment+BF advice, Outcome 1 Mastitis.

Comparison 1. Antibiotic versus no antibiotic

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mastitis Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Antibiotic versus no antibiotic

3

471

Risk Ratio (M‐H, Fixed, 95% CI)

0.43 [0.11, 1.61]

1.2 Antibiotic versus placebo

2

387

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.15, 6.68]

1.3 Antibiotic versus mupirocin

1

44

Risk Ratio (M‐H, Fixed, 95% CI)

0.44 [0.05, 3.89]

1.4 Antibiotic versus fusidic acid

1

36

Risk Ratio (M‐H, Fixed, 95% CI)

0.22 [0.03, 1.81]

1.5 Antibiotic versus breastfeeding advice

1

42

Risk Ratio (M‐H, Fixed, 95% CI)

0.17 [0.02, 1.28]

Figures and Tables -
Comparison 1. Antibiotic versus no antibiotic
Comparison 2. Breastfeeding education (specialist) versus usual care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mastitis Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 at hospital discharge

1

211

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 at 7 days

1

210

Risk Ratio (M‐H, Fixed, 95% CI)

3.75 [0.35, 40.70]

1.3 at 30 days

1

203

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.17, 4.95]

2 Sore nipples Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 at hospital discharge

1

211

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.72, 1.36]

2.2 at 7 days

1

210

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.66, 1.22]

2.3 at 30 days

1

203

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.36, 2.37]

3 Breast engorgement Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 at hospital discharge

1

211

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.03, 14.87]

3.2 at 7 days

1

210

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.71, 1.53]

3.3 at 30 days

1

203

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.73, 1.49]

4 Exclusive breastfeeding Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 at 7 days

1

210

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.90, 1.18]

4.2 at 30 days

1

203

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.68, 1.14]

5 Breastfeeding problems, mean per mother Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 at hospital discharge

1

211

Mean Difference (IV, Fixed, 95% CI)

0.20 [‐0.27, 0.67]

5.2 at 30 days

1

211

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.61, 0.21]

Figures and Tables -
Comparison 2. Breastfeeding education (specialist) versus usual care
Comparison 3. Anti‐secretory factor in cereal versus standard cereal

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mastitis Show forest plot

1

29

Risk Ratio (M‐H, Fixed, 95% CI)

0.24 [0.03, 1.72]

2 Mastitis recurrence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 First recurrence

1

29

Risk Ratio (M‐H, Fixed, 95% CI)

0.20 [0.01, 3.51]

2.2 Second recurrence

1

29

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.02, 10.45]

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Comparison 3. Anti‐secretory factor in cereal versus standard cereal
Comparison 4. Mupirocin ointment versus breastfeeding advice alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mastitis Show forest plot

1

48

Risk Ratio (M‐H, Fixed, 95% CI)

0.39 [0.12, 1.35]

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Comparison 4. Mupirocin ointment versus breastfeeding advice alone
Comparison 5. Fusidic acid ointment versus breastfeeding advice alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mastitis Show forest plot

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.77 [0.27, 2.22]

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Comparison 5. Fusidic acid ointment versus breastfeeding advice alone
Comparison 6. Mupirocin ointment+BF advice versus fusidic acid ointment+BF advice

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mastitis Show forest plot

1

42

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.13, 2.00]

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Comparison 6. Mupirocin ointment+BF advice versus fusidic acid ointment+BF advice