Flucloxacillin for Mastitis in Breastfeeding Women
Flucloxacillin is an excellent first-line antibiotic choice for treating mastitis in breastfeeding women due to its effectiveness against Staphylococcus aureus and minimal transfer into breast milk, making it safe for both mother and infant. 1, 2
Efficacy and Safety Profile
- Flucloxacillin is a penicillinase-resistant penicillin specifically designed to treat infections caused by beta-lactamase producing Staphylococcus aureus, the most common pathogen in bacterial mastitis 3
- Studies have shown extremely minimal transfer of flucloxacillin into breast milk:
Treatment Recommendations
Dosing and Duration
- Standard dosing: 500mg every 6 hours
- Treatment duration: 7-10 days 1
- Continue breastfeeding during treatment (this helps with breast emptying and speeds recovery) 1, 3
When to Use Flucloxacillin for Mastitis
- First-line therapy when clinical signs of infection are present:
Alternative Options
- For penicillin allergy: cephalosporins (if no anaphylaxis history) or clindamycin 1
- For suspected or confirmed MRSA: consider antibiotics with MRSA coverage 3, 4
Important Clinical Considerations
Breastfeeding Management During Treatment
- Continue breastfeeding from the affected breast during treatment 1, 5
- Frequent and complete emptying of the breast is essential for recovery 1, 3
- Position infant correctly to ensure effective milk removal 3
Monitoring
- Monitor infant for potential side effects (though extremely rare with flucloxacillin):
- Diarrhea
- Rash
- Unusual fussiness 1
- Complete the full course of antibiotics even if symptoms improve quickly
Evidence Quality
The recommendation for flucloxacillin in mastitis is based on:
- Clinical guidelines supporting penicillinase-resistant penicillins for mastitis 1
- Studies showing minimal transfer into breast milk 2
- Long clinical experience with this class of antibiotics during breastfeeding 5
While the Cochrane review notes limited high-quality RCTs specifically comparing antibiotics for mastitis 6, clinical practice guidelines and observational data strongly support the use of flucloxacillin as a safe and effective option for breastfeeding women with mastitis.