From the Guidelines
Mastitis treatment should involve continuing to breastfeed or express milk from the affected breast, along with antibiotics and supportive measures, to prevent milk stasis and promote recovery. The American Academy of Pediatrics recommends that mothers with mastitis continue to breastfeed, as regular feeding or expression of milk is an adjunct to other treatment 1. Antibiotics may be indicated, and approximately 10% of mastitis cases progress to breast abscesses, which require drainage.
Key considerations for mastitis treatment include:
- Continuing to breastfeed or express milk from the affected breast to prevent milk stasis and promote recovery
- Using antibiotics, such as dicloxacillin or cephalexin, for 10-14 days to treat bacterial mastitis
- Managing pain with ibuprofen or acetaminophen
- Applying warm compresses before feeding and cold compresses after to reduce pain and swelling
- Ensuring proper breastfeeding technique with complete breast emptying
- Staying hydrated and getting adequate rest to support recovery
It is essential to seek medical attention promptly if symptoms worsen after 48 hours of treatment, fever persists beyond 24 hours, or an abscess forms. Breastfeeding can continue on the affected side as long as the infant’s mouth does not contact purulent material 1.
In terms of specific antibiotic regimens, the choice of antibiotic depends on the suspected causative organism, with dicloxacillin or cephalexin being typical choices for bacterial mastitis. If MRSA is suspected, trimethoprim-sulfamethoxazole or clindamycin may be used instead. Pain management with ibuprofen or acetaminophen can help alleviate discomfort and promote recovery.
Overall, the goal of mastitis treatment is to eliminate the bacterial infection while maintaining milk flow to prevent complications like abscess formation, and continuing to breastfeed or express milk from the affected breast is a crucial part of this treatment.
From the Research
Mastitis Treatment Overview
- Mastitis is a spectrum of inflammatory conditions, with lactational mastitis being the most common, affecting approximately 10% of breastfeeding women in the United States 2, 3.
- The diagnosis of mastitis is usually clinical, based on symptoms such as fever, malaise, focal breast tenderness, and overlying skin erythema or hyperpigmentation 2, 3.
Treatment Approaches
- A 1- to 2-day trial of conservative measures, including nonsteroidal anti-inflammatory drugs, ice application, and frequent breastfeeding, is often sufficient for treatment 2.
- If symptoms do not improve, narrow-spectrum antibiotics may be prescribed to cover common skin flora, such as Staphylococcus and Streptococcus 2, 3.
- The use of probiotics for treatment or prevention is not supported by good evidence 2.
- Continued breastfeeding is generally encouraged in the presence of mastitis and does not pose a risk to the infant 3, 4.
Antibiotic Therapy
- There is insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for the treatment of lactational mastitis 5.
- Antibiotics effective against Staphylococcus aureus, such as dicloxacillin and cephalexin, are preferred 3.
- The emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a significant pathogen in soft-tissue infections, including mastitis, requires physicians to be aware of this bacteriologic shift and treat accordingly 6.
Prevention and Complications
- Proper lactation technique, including a good infant latch, and encouraging physiologic breastfeeding can help prevent mastitis 2.
- Factors that increase the risk of mastitis include overstimulation of milk production and tissue trauma from aggressive breast massage 2.
- Breast abscess is a common complication of mastitis, which can be prevented by early treatment and continued breastfeeding 3, 4.