What is the treatment for mastitis (inflammation of the breast) when it occurs while pumping breast milk?

Treatment of Mastitis While Pumping Breast Milk

For mastitis while pumping breast milk, treatment should include continued breast milk expression with proper technique, supportive measures, and antibiotics effective against Staphylococcus aureus such as amoxicillin-clavulanate or dicloxacillin for 7-10 days if symptoms persist beyond 24-48 hours of conservative management.

Diagnosis and Initial Management

Mastitis is an inflammation of the breast tissue that occurs in approximately 10% of breastfeeding women in the United States, typically within the first three months postpartum 1. The diagnosis is primarily clinical, based on:

• Focal breast tenderness
• Overlying skin erythema or hyperpigmentation
• Systemic symptoms (fever, malaise, fatigue)

Initial Conservative Management (1-2 days)

Since many cases of mastitis are primarily inflammatory rather than infectious, start with:

1. Continue pumping/breast emptying

   • Regular and complete emptying of the affected breast is essential 2
   • Do NOT stop pumping as this may worsen symptoms and lead to abscess formation

2. Pain management

   • NSAIDs (e.g., ibuprofen) for pain and inflammation 1
   • Apply cold compresses to reduce pain and swelling

3. Rest and hydration

   • Ensure adequate fluid intake
   • Get sufficient rest to support recovery

Antibiotic Therapy

If symptoms persist after 24-48 hours of conservative management or if symptoms are severe initially, antibiotic therapy should be initiated:

First-line antibiotics:

• Amoxicillin-clavulanate (first choice) for 7-10 days 2
• Dicloxacillin or cephalexin as alternatives 2, 3

These antibiotics effectively target Staphylococcus aureus, the most common pathogen in infectious mastitis 3.

For penicillin allergy:

• Cephalosporins (if no anaphylaxis history to penicillin)
• Clindamycin (monitor infant for GI side effects) 2

Continued Pumping During Treatment

The American Academy of Pediatrics emphasizes that continuing to express milk from the affected breast is crucial during treatment 4. Regular milk removal:

• Prevents milk stasis
• Reduces the risk of abscess formation
• Helps maintain milk supply
• Is safe for the infant even during antibiotic treatment

Monitoring for Complications

Watch for signs of breast abscess:

• Worsening symptoms despite antibiotics
• Fluctuant mass in the breast
• Persistent fever

If abscess is suspected, ultrasound evaluation is indicated, and drainage may be necessary 1, 5.

Risk of recurrence can be minimized by:

• Ensuring proper pumping technique
• Complete breast emptying
• Avoiding milk stasis

Special Considerations

1. MRSA concerns: If community MRSA rates are high or there's no response to initial therapy, consider coverage for resistant organisms 3

2. Milk cultures: Consider obtaining milk cultures in cases of:

   • Treatment failure
   • Recurrent mastitis
   • Hospital-acquired infections
   • Severe infections 1

Prevention Strategies

To prevent recurrence:

• Ensure proper pumping technique
• Maintain regular and complete breast emptying
• Avoid sudden changes in pumping frequency
• Address any nipple trauma promptly, as sore nipples can precipitate mastitis 3

The most recent evidence suggests avoiding excessive pumping to completely empty the breast, as overstimulation may actually increase the risk of mastitis 1. Instead, focus on regular, physiologic milk removal.