What is the initial treatment for mastitis?

Initial Treatment for Mastitis

The initial treatment for mastitis should include conservative measures such as continued breastfeeding, nonsteroidal anti-inflammatory drugs, and ice application for 1-2 days before considering antibiotics. 1

Understanding Mastitis

Mastitis is an inflammatory condition of the breast that occurs in approximately 10% of breastfeeding women in the United States, typically within the first three months postpartum 2, 1. It presents with:

• Focal breast tenderness with overlying skin erythema or hyperpigmentation 1
• Fever and systemic symptoms like malaise 1
• Pain during breastfeeding 2

Treatment Algorithm

First-Line Treatment (1-2 days)

• Continue breastfeeding from the affected breast to ensure complete emptying 1
• Apply ice to reduce inflammation 1
• Take nonsteroidal anti-inflammatory drugs for pain and inflammation 1
• Minimize pumping as excessive emptying may worsen inflammation 1
• Ensure proper latch and breastfeeding technique, possibly with assistance from a lactation consultant 2

Second-Line Treatment (if no improvement after 1-2 days)

• Antibiotics effective against Staphylococcus aureus, such as:
  • Dicloxacillin 2
  • Cephalexin 2
• Consider milk culture to guide antibiotic therapy in cases of:
  • Worsening symptoms 1
  • Recurrent mastitis 1
  • Immunocompromised patients 1

Severe Cases

• Ultrasound evaluation if abscess is suspected (worsening or recurrent symptoms) 1
• Intravenous antibiotics and hospital admission if condition worsens or sepsis is suspected 1
• Surgical drainage or needle aspiration if breast abscess develops 2

Important Considerations

Do's

• Continue breastfeeding during mastitis treatment - this is generally safe for the infant and helps resolve the condition 2, 3
• Complete the full course of antibiotics if prescribed 3
• Monitor for candida infection which may develop as a complication of antibiotic therapy 3

Don'ts

• Avoid aggressive breast massage as it may cause tissue trauma 1
• Avoid excessive heat application as it may worsen the condition 1
• Avoid excessive pumping to "empty" the breast 1

Prevention

• Proper lactation technique including good infant latch 1
• Physiologic breastfeeding rather than pumping when possible 1
• Frequent, complete emptying of the breast through effective breastfeeding 2
• Prompt treatment of sore nipples, which can precipitate mastitis 2

Evidence Limitations

• There is insufficient evidence from randomized controlled trials to confirm or refute the effectiveness of antibiotic therapy for lactational mastitis 4
• The use of probiotics for treatment or prevention is not supported by strong evidence 1

Remember that untreated or improperly treated mastitis may lead to breast abscess formation or premature cessation of breastfeeding, which can impact both maternal and infant health 2, 3.