First-Line Treatment for Lactational Mastitis
The first-line treatment for lactational mastitis includes continued breastfeeding along with antibiotics effective against Staphylococcus aureus, such as dicloxacillin or cloxacillin, with cephalexin as an alternative. 1
Diagnosis and Initial Management
- Continued breastfeeding is essential for recovery as it helps with milk removal and prevents milk stasis that can worsen inflammation 1
- Proper milk removal is crucial to prevent complications such as abscess formation
- Breastfeeding technique should be optimized, often with the assistance of a lactation consultant 2
Antibiotic Therapy
First-line antibiotics:
- Dicloxacillin or cloxacillin (first choice)
- Cephalexin (alternative option)
- Treatment duration: 10-14 days 1
These antibiotics are selected because they target Staphylococcus aureus, the most common causative organism in lactational mastitis 1, 2.
When to start antibiotics:
- If symptoms persist beyond 24-48 hours of conservative measures
- If there are signs of systemic illness (fever, malaise) 1
Supportive Measures
- Pain management: NSAIDs and acetaminophen for pain and inflammation
- Breast emptying: Ensure complete emptying of the affected breast through continued breastfeeding or pumping
- Warm compresses: Apply before feeding to improve milk flow
- Cold compresses: Apply after feeding to reduce pain and swelling
- Rest and hydration: Ensure adequate fluid intake and rest
Monitoring and Follow-up
- Improvement should be seen within 48 hours of starting appropriate treatment
- If symptoms persist despite antibiotic therapy, consider:
- Breast abscess formation (may require drainage)
- Resistant organisms
- Mammary candidiasis (which would require antifungal therapy) 1
Prevention Strategies
- Proper lactation technique with good infant latch
- Physiologic breastfeeding rather than excessive pumping
- Prompt treatment of sore nipples 1
- Frequent, complete emptying of the breast 2
Special Considerations
- Mastitis affects approximately 10% of breastfeeding women in the US 2
- Untreated mastitis can lead to breast abscess formation, which may require surgical drainage or needle aspiration 2
- As methicillin-resistant S. aureus becomes more common, it may become a more frequent cause of mastitis, potentially changing first-line antibiotic recommendations 2
Lactational mastitis is a common condition that, when properly managed with continued breastfeeding and appropriate antibiotics, typically resolves without complications. Early intervention is key to preventing progression to more serious conditions like breast abscess.