From the Guidelines
The treatment for mastitis should include continued breastfeeding or milk expression, along with antibiotics and pain management, as this approach has been shown to effectively manage the condition while minimizing the risk of complications and promoting recovery. According to the most recent guidelines, mothers with mastitis are encouraged to continue breastfeeding, as regular feeding or expression of milk is an adjunct to other treatment 1. Antibiotics may be indicated, with approximately 10% of mastitis cases progressing to breast abscesses, which require drainage.
Key considerations in the treatment of mastitis include:
- The use of oral antibiotics such as dicloxacillin, cephalexin, or amoxicillin-clavulanate for 10-14 days, with dosages typically around 500mg four times daily.
- Pain management with ibuprofen (400-600mg every 6 hours) or acetaminophen (650-1000mg every 4-6 hours).
- Continued breastfeeding or expressing milk from the affected breast to prevent milk stasis and abscess formation.
- The application of warm compresses before feeding and cold packs after to help reduce pain and inflammation.
- Adequate rest, increased fluid intake, and wearing a supportive, non-underwire bra are also important components of treatment.
It's essential to note that mastitis occurs when milk ducts become blocked and infected, often by bacteria that enter through cracked nipples, so proper breastfeeding technique and breast care can help prevent recurrence. Most cases improve within 24-48 hours of starting antibiotics, but the full course should be completed to prevent relapse. The American Academy of Pediatrics guidelines support the continuation of breastfeeding in mothers with mastitis, emphasizing the importance of this practice for both the mother's and the infant's health 1.
From the Research
Treatment for Mastitis
The treatment for mastitis typically involves a combination of measures to alleviate symptoms and address the underlying cause. Some key aspects of treatment include:
- Frequent and complete emptying of the breast to reduce the risk of mastitis and prevent its progression 2
- Optimizing breastfeeding technique, often with the assistance of a lactation consultant, to prevent sore nipples and reduce the risk of mastitis 2
- Using antibiotics effective against Staphylococcus aureus, such as dicloxacillin or cephalexin, when necessary 2, 3
- Continuing breastfeeding, as it generally does not pose a risk to the infant and can help to prevent the development of a breast abscess 2
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 complications, but the evidence is not yet conclusive 4. The choice of antibiotic should be guided by the results of milk culture and sensitivity testing, and dicloxacillin or cloxacillin may be suitable options 3. It is also important to note that the transfer of dicloxacillin into human milk is minimal, and the relative infant dose is considered to be safe 5.
Prevention of Complications
Preventing complications, such as breast abscess, is an important aspect of mastitis treatment. Early treatment of mastitis and continued breastfeeding can help to prevent the development of an abscess 2. If an abscess does occur, surgical drainage or needle aspiration may be necessary 2.
Management of Mastitis
The management of mastitis should be individualized and take into account the severity of symptoms, the presence of any underlying conditions, and the results of diagnostic tests. Effective milk removal, pain management, and antibiotic therapy (when necessary) are all important components of mastitis treatment 4, 3.