From the Guidelines
For mastitis in a breastfeeding mother, antibiotics such as amoxicillin or cephalexin are recommended as they are effective against Staphylococcus aureus, the most common causative organism, and are considered safe during breastfeeding 1. When choosing an antibiotic, it's essential to consider the safety profile during breastfeeding. According to the evidence, most systemic antibiotics will be present in breast milk, which could cause falsely negative cultures in febrile infants or produce gastroenteritis due to alteration of intestinal flora 1. Some key points to consider when selecting an antibiotic for mastitis in a breastfeeding mother include:
- Amoxicillin is considered safe during breastfeeding, with a low risk of oral clefts associated with exposure during organogenesis 1.
- Cephalexin is also a suitable option, with human data indicating that cephalosporins are not teratogenic at usual therapeutic doses 1.
- Azithromycin and clarithromycin are macrolides that may be associated with a low risk of hypertrophic pyloric stenosis in infants exposed during the first 13 days of breastfeeding 1. It's crucial to note that while taking antibiotics, mothers should continue breastfeeding or expressing milk from the affected breast to prevent milk stasis, which can worsen the infection. Applying warm compresses before feeding and cold compresses after can help reduce pain and inflammation. Adequate rest, hydration, and over-the-counter pain relievers like ibuprofen can also help manage symptoms. If symptoms don't improve within 48 hours of starting antibiotics, or if the mother develops a high fever or severe pain, she should seek immediate medical attention as this could indicate an abscess requiring drainage.
From the FDA Drug Label
Nursing Mothers Penicillins are excreted in breast milk. Caution should be exercised when penicillins are administered to a nursing woman
Limited published data based on breast milk sampling reports that clindamycin appears in human breast milk in the range of less than 0.5 to 3. 8 mcg/mL.
Antibiotics recommended for mastitis in a breast-feeding mother are not explicitly stated in the provided drug labels.
- Dicloxacillin and clindamycin are mentioned, but their use in breast-feeding mothers is cautioned due to excretion in breast milk.
- The decision to use these antibiotics should be made with caution, considering the potential risks and benefits, and under the guidance of a healthcare professional 2 3.
From the Research
Antibiotics for Mastitis in Breast-Feeding Mothers
- The antibiotics recommended for mastitis in breast-feeding mothers are those effective against Staphylococcus aureus, such as dicloxacillin and cephalexin 4.
- Dicloxacillin is a commonly used antibiotic for lactational mastitis, and its transfer into human milk is minimal, with a relative infant dose (RID) of 0.03% 5.
- When antibiotics are warranted, dicloxacillin or cloxacillin are suggested as first-line drugs, as they are effective against Staphylococcus aureus and have minimal transfer to breast milk 6.
- There is insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for the treatment of lactational mastitis, and high-quality, double-blinded RCTs are needed to determine the best course of treatment 7.
Considerations for Antibiotic Use
- The diagnosis of mastitis is usually clinical, with patients presenting with focal tenderness in one breast accompanied by fever and malaise, and the differential diagnosis includes mechanical irritation, bacterial or yeast infection 4.
- Effective milk removal is an essential part of the treatment and may make antibiotics superfluous, and culture of the milk is necessary to determine the infecting organism and its antibiotic sensitivity 6.
- Breast-feeding can usually continue in the presence of mastitis and generally does not pose a risk to the infant, and continued breastfeeding is encouraged to prevent complications such as breast abscess 4.