From the Research
Neonatal mastitis should be treated promptly with antibiotics to prevent progression to abscess formation, with a recommended treatment of a 7-10 day course of an antistaphylococcal antibiotic such as flucloxacillin or cephalexin. The choice of antibiotic should be guided by the suspected or confirmed causative pathogen, with consideration of methicillin-resistant Staphylococcus aureus (MRSA) if suspected or confirmed, in which case clindamycin may be appropriate 1. For infants with severe infection, hospitalization and intravenous antibiotics may be necessary, typically nafcillin or oxacillin 1. Supportive care includes warm compresses to the affected breast several times daily, gentle massage, and ensuring adequate hydration.
Key Considerations
- The most common cause of neonatal mastitis is Staphylococcus aureus, which enters through minor abrasions in the skin and causes inflammation of the breast tissue 2.
- Prompt treatment is essential as the thin-walled blood vessels in neonates can allow bacteria to enter the bloodstream, potentially leading to sepsis if left untreated 1.
- Evaluation for serious bacterial infection (SBI) is likely unnecessary in most afebrile, well-appearing infants with mastitis, as SBI and adverse outcomes are rare 1.
- Surgical drainage is only indicated if an abscess has formed, which occurs in approximately 5-10% of cases.
Treatment Approach
- A 7-10 day course of an antistaphylococcal antibiotic such as flucloxacillin (50 mg/kg/day divided into four doses) or cephalexin (50 mg/kg/day divided into four doses) is recommended 1.
- If MRSA is suspected or confirmed, clindamycin (30 mg/kg/day divided into three doses) may be appropriate.
- For infants with severe infection, hospitalization and intravenous antibiotics may be necessary, typically nafcillin or oxacillin (100-150 mg/kg/day divided into four doses) 1.
- Parents should be advised to continue normal feeding and to monitor for signs of worsening infection such as increased redness, swelling, or fever.
Recent Evidence
- A recent study found that mild localized disease is typical of neonatal mastitis, and serious bacterial infection and adverse outcomes are rare 1.
- Another study found that the use of vancomycin could be restricted to specific cases, and that cefazolin may be an effective alternative for the treatment of coagulase-negative staphylococcal sepsis in neonates 3.