From the Research
The recommended treatment for mastitis in pregnancy involves a 1- to 2-day trial of conservative measures, such as nonsteroidal anti-inflammatory drugs, ice application, feeding the infant directly from the breast, and minimizing pumping, before considering narrow-spectrum antibiotics to cover common skin flora, as most cases are caused by inflammation and not a true infection 1.
Key Considerations
- Diagnosis is made clinically based on symptoms such as fever, malaise, focal breast tenderness, and overlying skin erythema or hyperpigmentation without the need for laboratory tests or imaging 1.
- Obtaining milk cultures should be considered to guide antibiotic therapy, and ultrasonography should be performed to identify abscesses in immuno-compromised patients or those with worsening or recurrent symptoms 1.
- Factors that increase the risk of mastitis include overstimulation of milk production and tissue trauma from aggressive breast massage; therefore, frequent overfeeding, excessive pumping to empty the breast, heat application, and breast massage are no longer recommended because they may worsen the condition 1.
Treatment Approach
- Conservative measures are often sufficient for treatment, and antibiotics may be prescribed if there is no improvement in symptoms 1.
- Narrow-spectrum antibiotics, such as those effective against Staphylococcus and Streptococcus, may be used to cover common skin flora 1.
- Most patients can be treated as outpatients with oral antibiotics; however, if the condition worsens or there is a concern for sepsis, intravenous antibiotics and hospital admission may be required 1.
Prevention
- The best prevention is a proper lactation technique, including a good infant latch, and encouraging physiologic breastfeeding rather than pumping, if possible 1.