What is the treatment for mastitis, especially when caused by a bacterial infection?

From the Guidelines

The primary treatment for bacterial mastitis is antibiotics, typically a 10-14 day course of medications such as dicloxacillin (500 mg four times daily), cephalexin (500 mg four times daily), or clindamycin (300 mg four times daily) for penicillin-allergic patients. While taking antibiotics, continue breastfeeding or expressing milk regularly to prevent engorgement and help clear the infection. Pain management with ibuprofen (400-600 mg every 6 hours) or acetaminophen (650-1000 mg every 6 hours) can reduce inflammation and discomfort. Apply warm compresses before feeding and cold packs after to improve milk flow and reduce swelling. Ensure proper breastfeeding technique with complete breast emptying, and get adequate rest and hydration to support recovery. Most cases improve within 24-48 hours of starting antibiotics, but complete the full course to prevent recurrence. Bacterial mastitis requires prompt treatment to prevent complications like abscess formation, which may require surgical drainage if antibiotics alone are insufficient 1.

Some key points to consider:

• The choice of antibiotic may depend on the severity of the infection and the patient's allergy history.
• Breastfeeding can continue during treatment with most antibiotics, but it's essential to consult with a healthcare provider to ensure the safety of the medication for the baby.
• Regular expression of milk can help prevent engorgement and promote healing.
• Pain management and comfort measures, such as warm compresses and cold packs, can help alleviate symptoms.
• It's crucial to complete the full course of antibiotics to prevent recurrence and complications.

In general, the treatment of bacterial mastitis aims to eliminate the infection, relieve symptoms, and prevent complications, while also supporting the continuation of breastfeeding when possible 1.

From the Research

Treatment of Mastitis

The treatment of mastitis, especially when caused by a bacterial infection, involves several key components:

• Effective milk removal: This is considered an essential part of the treatment and may make antibiotics superfluous 2.
• Antibiotic therapy: When antibiotics are needed, those effective against Staphylococcus aureus (e.g., dicloxacillin, cephalexin) are preferred 3, 2.
• Pain medication: This is often used in conjunction with antibiotic therapy to relieve symptoms 4, 5.
• Breastfeeding technique optimization: Changing breastfeeding technique, often with the assistance of a lactation consultant, can help to prevent and treat mastitis 3.

Antibiotic Therapy

The use of antibiotic therapy in the treatment of mastitis is a topic of ongoing debate:

• Some studies suggest that antibiotics may be effective in relieving symptoms and preventing abscess formation 3, 2.
• However, other studies have found insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for the treatment of lactational mastitis 4, 5.
• The choice of antibiotic should be based on the suspected or confirmed causative organism and its antibiotic sensitivity 2.

Continued Breastfeeding

Continued breastfeeding is generally recommended in the presence of mastitis:

• Breastfeeding can usually continue in the presence of a treated abscess 3.
• Effective milk removal and continued breastfeeding can help to prevent the development of a breast abscess 3, 2.
• Women with mastitis can continue to breastfeed from the affected breast during treatment 2.