Should breastfeeding be avoided with Methicillin-resistant Staphylococcus aureus (MRSA) mastitis?

Breastfeeding Should Continue with MRSA Mastitis

Mothers with MRSA mastitis should continue breastfeeding while receiving appropriate treatment, as long as the infant's mouth does not directly contact purulent drainage from the breast. 1

Management of MRSA Mastitis During Breastfeeding

Continuation of Breastfeeding

• Breastfeeding should be encouraged to continue during mastitis, including MRSA mastitis, as regular feeding or expression of milk is an important adjunct to other treatments 1
• Continued breastfeeding helps with breast emptying, which is essential for recovery and prevents milk stasis that can worsen the infection 2
• Breastfeeding generally does not pose a risk to the infant when the mother has mastitis 2

Treatment Approach

• Antibiotics effective against MRSA should be initiated when MRSA mastitis is diagnosed 2
• Frequent and complete emptying of the breast should be encouraged to reduce the risk of complications 2
• Optimizing breastfeeding technique, often with assistance from a lactation consultant, is an important component of treatment 2

Medication Considerations

• When antibiotics are needed for MRSA, those that are safe during lactation should be selected 3
• Most antibiotics used to treat MRSA appear to be relatively safe in the minimal quantities that nursing infants ingest through breast milk 3
• Close monitoring of breastfed infants is recommended when mothers are receiving antibiotics for MRSA skin and soft tissue infections 3

Special Considerations and Precautions

When to Modify Breastfeeding

• If a breast abscess develops (occurs in approximately 10% of mastitis cases), breastfeeding can continue on the affected side as long as the infant's mouth does not contact purulent drainage 1
• If direct contact with purulent drainage cannot be avoided, temporary expression of milk from the affected breast may be necessary until drainage resolves 1

Prevention of Complications

• Early and appropriate treatment of mastitis helps prevent breast abscess formation 2
• If an abscess occurs, surgical drainage or needle aspiration is needed, but breastfeeding can usually continue with proper management 2
• Without proper treatment, mastitis may lead to premature cessation of breastfeeding, which would deprive the infant of nutritional and immunological benefits 4, 5

Benefits of Continuing Breastfeeding

• Stopping breastfeeding during infection only deprives the infant of nutritional and potential immunologic benefits 4
• In most cases of suspected infection, the infant has already been exposed by the time the diagnosis is made 4
• The American Academy of Pediatrics recommends exclusive breastfeeding for 6 months, with continued breastfeeding for 1 year or longer as mutually desired 5

Evidence Quality and Recommendations

• Current guidelines from the American Academy of Pediatrics strongly support continued breastfeeding during mastitis 1
• While there is insufficient evidence from randomized controlled trials to confirm the effectiveness of specific antibiotic therapies for lactational mastitis 6, clinical practice guidelines recommend appropriate antibiotics along with continued breastfeeding 1
• The benefits of breastfeeding generally outweigh the potential risks of transmission of infection through breast milk in cases of mastitis 4

In conclusion, MRSA mastitis should not lead to cessation of breastfeeding. With appropriate antibiotic treatment, continued breast emptying, and proper breastfeeding technique, mothers can continue to provide the benefits of breast milk to their infants while effectively treating the infection.