What are the treatment options for mastitis and urinary tract infections (UTIs)?

Treatment for Mastitis and Urinary Tract Infections (UTIs)

For mastitis, dicloxacillin or cephalexin is the first-line treatment, while for UTIs, nitrofurantoin, fosfomycin, or trimethoprim-sulfamethoxazole are recommended first-line options based on local resistance patterns. 1, 2

Mastitis Treatment

Mastitis affects approximately 10% of breastfeeding women in the US and requires prompt treatment to prevent complications and preserve breastfeeding 1.

First-line approach:

• Effective milk removal is essential and may be sufficient in inflammatory mastitis 3
• Continue breastfeeding from the affected breast to prevent milk stasis 1
• Consider consulting a lactation specialist to optimize breastfeeding technique 1

Antibiotic therapy:

• Indicated when symptoms include significant inflammation, fever, or systemic symptoms 3
• First-line antibiotics (effective against Staphylococcus aureus):
  • Dicloxacillin or cloxacillin 3
  • Cephalexin as an alternative 1
• Treatment duration: 7-14 days 1

Important considerations:

• Continued breastfeeding during treatment is safe and recommended 1, 3
• Milk culture may be necessary if symptoms don't improve or in cases of recurrent mastitis 3
• Monitor for breast abscess formation, which may require drainage 1

Urinary Tract Infection Treatment

Uncomplicated UTIs in women:

First-line antibiotics:

• Nitrofurantoin 100 mg twice daily for 5 days 2
• Fosfomycin trometamol 3 g single dose 2
• Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days (if local resistance <20%) 2, 4

Alternative options:

• Cephalosporins (e.g., cefadroxil 500 mg twice daily for 3 days) 2
• Amoxicillin-clavulanate for complicated UTIs 5

UTIs in men:

• Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 7 days 2
• Fluoroquinolones based on local susceptibility patterns 2

Special considerations:

• Urine culture recommended for:
  • Suspected pyelonephritis
  • Symptoms that don't resolve within 4 weeks after treatment
  • Women with atypical symptoms
  • Pregnant women 2
• For symptoms that don't resolve by end of treatment or recur within 2 weeks, perform urine culture and select a different antibiotic for retreatment 2

Recurrent UTIs

Definition:

• At least three UTIs per year or two UTIs in the last 6 months 2

Prevention strategies:

• Increase fluid intake in premenopausal women 2
• Vaginal estrogen replacement in postmenopausal women 2
• Consider immunoactive prophylaxis 2
• Probiotics containing specific strains for vaginal flora regeneration 2
• Cranberry products may help reduce recurrences, though evidence is mixed 2

Antibiotic prophylaxis:

• Should be considered only after counseling and behavioral modifications have been attempted 2
• Confirm eradication of previous UTI with negative urine culture before starting prophylaxis 2
• Options include:
  • Continuous daily prophylaxis for 6-12 months 2
  • Post-coital prophylaxis for sexually associated UTIs 2
  • Nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin are preferred options 2

Common pitfalls to avoid:

• Treating asymptomatic bacteriuria (except in pregnancy or before urologic procedures) 2
• Using fluoroquinolones as first-line therapy due to risk of adverse effects and resistance 2
• Prolonged antibiotic courses (>5 days) for uncomplicated UTIs, which can disrupt normal flora 2
• Using nitrofurantoin in febrile infants with UTIs, as it doesn't achieve therapeutic blood concentrations 2

By following these evidence-based approaches to treating mastitis and UTIs, you can effectively manage these common infections while minimizing complications and antibiotic resistance.