From the Guidelines
The most effective management for mastitis involves applying warm compresses before feeding to improve milk flow, while cold compresses after feeding can help reduce inflammation, alongside continued breastfeeding, pain management, and antibiotics when necessary. When considering the management of mastitis, it's crucial to prioritize approaches that reduce morbidity, mortality, and improve quality of life. The application of warm or cold compresses is a common practice, but the most recent and highest quality evidence supports the use of warm compresses before feeding to facilitate milk flow and cold compresses after feeding to decrease inflammation 1. Key aspects of mastitis management include:
- Continued breastfeeding or expression of milk from the affected breast to prevent milk stasis and promote drainage.
- Pain management with over-the-counter analgesics like ibuprofen or acetaminophen.
- Antibiotics effective against Staphylococcus aureus for infectious mastitis, such as dicloxacillin, cephalexin, or clindamycin for penicillin-allergic patients.
- Supportive measures including adequate rest, increased fluid intake, and proper breastfeeding technique to prevent future episodes. It's essential to initiate treatment promptly and continue for the full course to prevent complications like abscess formation. If symptoms do not improve within 48 hours of antibiotic therapy, further evaluation is necessary to rule out an abscess or other complications. The evidence from 1 emphasizes the importance of breastfeeding and its benefits, which indirectly supports the continuation of breastfeeding during mastitis treatment, aligning with the recommendation to continue breastfeeding as part of mastitis management.
From the Research
Management of Mastitis
- The recommended management for mastitis includes effective milk removal, pain medication, and antibiotic therapy 2, 3, 4.
- Breast emptying alone as "supportive therapy" versus antibiotic therapy plus supportive therapy has been compared in studies, with findings suggesting faster clearance of symptoms for women using antibiotics, although the study design was problematic 2, 3.
- There is insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for the treatment of lactational mastitis, and an urgent need to conduct high-quality, double-blinded randomized clinical trials to determine whether antibiotics should be used in this common postpartum condition 2, 3.
- In addition to antibiotics, management of lactational breast infections includes symptomatic treatment, assessment of the infant's attachment to the breast, and reassurance, emotional support, education and support for ongoing breastfeeding 4.
Cold vs Warm Application
- There is no direct evidence in the provided studies regarding the use of cold or warm applications for the management of mastitis.
- The studies focus on the effectiveness of antibiotic therapies, supportive therapy, and hygiene practices in preventing and treating mastitis 5, 2, 3, 4, 6.
- Further research is needed to determine the effectiveness of cold or warm applications in the management of mastitis.
Prevention and Treatment
- Mastitis can be caused by ineffective positioning of the baby at the breast or restricted feeding, and infective mastitis is commonly caused by Staphylococcus aureus 2, 3.
- The prevalence of mastitis in breastfeeding women may reach 33%, and effective milk removal, pain medication, and antibiotic therapy have been the mainstays of treatment 2, 3.
- Lactational mastitis is usually bacterial in aetiology and can generally be effectively managed with oral antibiotics, and infections that do not improve rapidly require further investigation for breast abscess and nonlactational causes of inflammation 4.