When to use antibiotics in mastitis (inflammation of the breast tissue)?

From the Guidelines

Antibiotics should be used in mastitis when there are clear signs of infection, such as fever, significant breast inflammation, or systemic symptoms, as indicated by the most recent guidelines from the American Academy of Pediatrics 1.

Key Considerations

• The decision to use antibiotics in mastitis should be based on the severity of symptoms and the presence of signs of infection, rather than solely on the diagnosis of mastitis.
• Start antibiotics promptly if symptoms are severe or worsening rapidly, or if there's no improvement after 12-24 hours of frequent breast emptying and supportive measures.
• The recommended first-line treatment is usually dicloxacillin or cephalexin, 500 mg orally four times daily for 10-14 days, as supported by the guidelines 1.

Indications for Antibiotics

• High fever (>101.3°F or 38.5°C)
• Visible signs of infection like redness, swelling, and warmth in the breast
• Systemic symptoms such as chills or malaise
• No improvement after 12-24 hours of conservative management

Conservative Management

• Frequent breast emptying
• Rest
• Pain relief measures
• Antibiotics are necessary in cases of severe mastitis to prevent the infection from worsening and potentially leading to abscess formation, as highlighted by the guidelines 1.

Important Notes

• Not all cases of mastitis require antibiotics, as some mild cases can resolve with conservative management alone.
• Mothers with mastitis are encouraged to continue breastfeeding, as regular feeding or expression of milk is an adjunct to other treatment, as recommended by the American Academy of Pediatrics 1.

From the Research

Diagnosis and Treatment of Mastitis

• Mastitis is a spectrum of inflammatory conditions, with lactational mastitis being the most common, occurring in approximately 10% of breastfeeding women in the United States 2, 3.
• Diagnosis is typically made clinically, based on symptoms such as fever, malaise, focal breast tenderness, and overlying skin erythema or hyperpigmentation 2, 3.
• Treatment often involves a 1- to 2-day trial of conservative measures, including nonsteroidal anti-inflammatory drugs, ice application, and frequent breastfeeding 3.

Use of Antibiotics in Mastitis

• Antibiotics may be prescribed if there is no improvement in symptoms after conservative measures, with narrow-spectrum antibiotics covering common skin flora such as Staphylococcus and Streptococcus 2, 3.
• The use of antibiotics is generally recommended when bacterial mastitis is suspected, with dicloxacillin or cloxacillin suggested as first-line drugs 2, 4.
• It is essential to obtain milk cultures to guide antibiotic therapy and determine the infecting organism and its antibiotic sensitivity 3, 4.

Prevention and Management of Mastitis

• Proper lactation technique, including a good infant latch, and encouraging physiologic breastfeeding rather than pumping, can help prevent mastitis 3.
• Frequent, complete emptying of the breast and optimizing breastfeeding technique can reduce the risk of mastitis 2.
• Continued breastfeeding is generally encouraged in the presence of mastitis and does not pose a risk to the infant 2, 4.