Dr. Newman's All-Purpose Nipple Ointment (APNO)

Breastfeeding Recipe: How To Make And Use APNO

Dr. Jack Newman's All Purpose Nipple Ointment Recipe
A compounding pharmacy can prepare Dr. Jack's APNO for you. Medic Image/Universal Images Group/Getty Images

What Is Dr. Jack Newman's All-Purpose Nipple Ointment (APNO)?

Dr. Jack Newman's All-Purpose Nipple Ointment (APNO) is one of the most popular nipple-healing and infection-preventing recipes used by breastfeeding mothers. This triple nipple ointment consists of three properties -- an antibiotic, an anti-inflammatory, and an anti-fungal. 

What Is APNO Used to Treat?

Dr. Jack's All-Purpose Nipple Ointment is used to treat and heal sore nipples that may arise from:

How to Make APNO: The Recipe

Talk to your doctor and ask for a detailed prescription for APNO. Certain pharmacies, known as compounding pharmacies, can prepare this ointment for you. If you cannot find a pharmacy to make this for you, it is easy enough for you to make it on your own. Here's what you need to make your own APNO:

  • The antibiotic: Bactroban (mupirocin) 2% ointment (not cream): 15 grams. You'll need to get a prescription from your doctor for this ingredient. If mupirocin is not available, bacitracin can be used although it is not as effective. An antibiotic helps to heal nipple pain by stopping the growth of bacteria.  Preventing the growth of bacteria on the nipples can also help protect against mastitis.  
     
  • The anti-inflammatory: Betamethasone 0.1% ointment (not cream): 15 grams. You can get this over-the-counter. Betamethasone is a corticosteroid. It lessens the pain by reducing any swelling caused by injury, infection, or skin irritation.  
     
  • The anti-fungal: Miconazole powder, so that the final concentration is 2% miconazole. Miconazole is preferred, but you can use 2% clotrimazole powder or 15 grams of Nystatin ointment if miconazole is not available. If you use powder instead of ointment, you will get a better concentration of your antifungal agent (miconazole or clotrimazole), and the concentrations of the mupirocin and betamethasone will remain higher. You can get this over-the-counter. The anti-fungal in this recipe fights off Candida. Candida is a yeast that causes thrush. 
     
  • Sometimes it is helpful to add ibuprofen powder as well so that the final concentration of ibuprofen is 2%.
     
  • Combine all the ingredients in equal parts. Once the mixture is complete, you should have a total volume of approximately 30 grams or 1 ounce of APNO.
     

How to Use Your APNO

Apply a tiny amount of your APNO mixture to your nipples and areola after each breastfeeding session. You do not need to wash this ointment off before the next feeding.  You should only be using a very small amount, so it will not harm your baby.  

How to Use APNO Along with Gentian Violet

Gentian violet is an over-the-counter product that is used to treat thrush. It can be found in natural food stores and can be used as a combination treatment along with APNO. The recommended way to follow this combination treatment is as follows:

Use gentian violet once a day for 3 or 4 days. Take a cotton swab and dip it into a .5 to 1 percent solution of gentian violet. Spread the gentian violet in the baby's mouth and onto the nipples then breastfeed the baby.

If necessary, coat the nipples with gentian violet after the feeding, as well. Remember, only once a day.

Use APNO for all other feedings. Do not use APNO for the feeding that you apply gentian violet. Apply APNO after every other feeding during the day. 

Sources:

Handout #3b. Treatments for sore nipples and sore breasts. January 2005. Written by Jack Newman, MD, FRCPC.

Newman, Jack, MD, Pitman, Theresa. The Ultimate Breastfeeding Book of Answers. Three Rivers Press. New York. 2006.

 

Edited by Donna Murray

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