From the Guidelines
Mastitis should be treated with continuation of breastfeeding and expression of milk from the affected breast, as well as supportive care including rest, hydration, and applying warm compresses to the affected breast 1.
Treatment Options
- Supportive care: rest, hydration, and applying warm compresses to the affected breast
- Pain management: over-the-counter pain relievers such as acetaminophen or ibuprofen can help alleviate symptoms
- Antibiotics: a 10-14 day course of antibiotics such as dicloxacillin or cephalexin may be prescribed if symptoms persist or worsen
- Breast abscess drainage: may be necessary in some cases
Important Considerations
- Continue breastfeeding: unless otherwise advised by a healthcare provider, continue breastfeeding or expressing milk from the affected breast to help clear the infection 1
- Monitor symptoms: if symptoms do not improve within 24-48 hours of treatment, or if severe symptoms such as fever over 101.5°F, severe pain, or difficulty moving the arm occur, seek immediate medical attention
- Regular feeding or expression of milk: is an adjunct to other treatment and can help prevent the progression of mastitis to breast abscesses 1
From the FDA Drug Label
The penicillinase-resistant penicillins are available for oral administration and for intramuscular and intravenous injection... Bacteriologic studies to determine the causative organisms and their sensitivity to the penicillinase-resistant penicillins should always be performed.
RECOMMENDED DOSAGES FOR DICLOXACILLIN SODIUM, USP IN MILD TO MODERATE AND SEVERE INFECTIONS
The treatment options for mastitis are not explicitly mentioned in the provided drug label. However, since mastitis is typically caused by Staphylococcal infections, the treatment options for severe Staphylococcal infections can be considered.
- The recommended dosage for dicloxacillin in severe infections is 250 mg every 6 hours for adults.
- The treatment should be continued for at least 14 days in severe Staphylococcal infections.
- Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative 2.
From the Research
Treatment Options for Mastitis
The treatment options for mastitis include:
- Supportive counselling, warm or cold compresses, effective milk removal, oral antibiotic therapy, and symptomatic treatment 3
- Antibiotics, with the most commonly prescribed being di/flucloxacillin or cefalexin 4
- Analgesia, although this is not always included in treatment guidelines 4
- Investigations such as ultrasound, blood tests, and breast milk or nipple swab cultures, although these are not always necessary 4
- Probiotics and bacteriocins as alternative treatments, particularly in cases where antibiotic resistance is a concern 5
- Suction/drainage needle for abscesses under 5 cm, involving antibiotic therapy 6
- Steroid therapy or surgery for idiopathic granulomatous mastitis, although the best approach is not always clear 6, 7
- Intralesional triamcinolone injections for idiopathic granulomatous mastitis, although this may require the patient to stop breastfeeding from the affected breast 7
Considerations for Breastfeeding Women
For breastfeeding women with mastitis, considerations include:
- The need to continue breastfeeding, even if this means unilateral breastfeeding 3, 7
- The potential impact of treatment on milk production and latch 7
- The need for individualized care and support to manage symptoms and promote continued breastfeeding 7
- The potential side effects of systemic steroids and the need to wean a breast being treated with intralesional steroids 7
- The importance of augmenting milk production on the unaffected breast to promote continued breastfeeding 7