From the Guidelines
Antibiotics are indicated in mastitis when there is evidence of bacterial infection, such as purulent discharge, fever, or significant erythema and swelling, as this can help reduce the risk of morbidity and mortality, and improve quality of life 1.
Key Considerations
- For lactational mastitis, antibiotics like dicloxacillin or cephalexin are recommended, with a typical dose of 250-500 mg orally every 6 hours for 10-14 days.
- For non-lactational mastitis, antibiotics like cephalexin or amoxicillin-clavulanate are recommended, with a typical dose of 250-500 mg orally every 6-8 hours for 10-14 days.
- In severe cases, hospitalization and intravenous antibiotics like oxacillin or cefazolin may be necessary.
- Breastfeeding can continue on the affected side as long as the infant’s mouth does not contact purulent, and regular feeding or expression of milk is an adjunct to other treatment.
- Approximately 10% of mastitis cases progress to breast abscesses, which require drainage.
Important Notes
- Antibiotics should only be used when a bacterial infection is suspected, and not for mastitis caused by other factors.
- The decision to use antibiotics should be based on a thorough evaluation of the patient's symptoms and medical history, and should be made in consultation with a healthcare professional.
- It is essential to weigh the benefits and risks of antibiotic use, and to consider alternative treatments when possible, to minimize the risk of antibiotic resistance and other adverse effects.
From the Research
Indications for Antibiotics in Mastitis
Antibiotics are indicated in mastitis when there is a suspected bacterial infection, particularly with Staphylococcus aureus or Streptococcus 2, 3. The diagnosis of mastitis is usually clinical, with patients presenting with focal tenderness in one breast accompanied by fever and malaise.
Treatment Approach
- A 1- to 2-day trial of conservative measures, such as nonsteroidal anti-inflammatory drugs, ice application, and frequent breastfeeding, is often sufficient for treatment 2.
- If there is no improvement in symptoms, narrow-spectrum antibiotics may be prescribed to cover common skin flora, such as Staphylococcus and Streptococcus 2, 3.
- Antibiotics effective against Staphylococcus aureus, such as dicloxacillin and cephalexin, are preferred 3.
Specific Situations
- In cases of suspected methicillin-resistant S. aureus, antibiotics effective against this organism may be preferred 3.
- If the condition worsens or there is a concern for sepsis, intravenous antibiotics and hospital admission may be required 2.
- Breast abscesses, a common complication of mastitis, may require surgical drainage or needle aspiration, but breastfeeding can usually continue in the presence of a treated abscess 3, 4.