Treatment of Mastitis
For lactational mastitis, treatment should begin with conservative measures for 1-2 days, including continued breastfeeding, NSAIDs, and ice application, followed by antibiotics if symptoms persist. 1
Initial Management Approach
- Mothers with mastitis should be encouraged to continue breastfeeding. Regular feeding or expression of milk is an essential part of treatment 2
- Apply conservative measures for 1-2 days as first-line treatment 1:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation
- Ice application to reduce inflammation
- Feed the infant directly from the affected breast
- Minimize excessive pumping which can worsen inflammation
When to Use Antibiotics
- If no improvement occurs after 1-2 days of conservative measures, narrow-spectrum antibiotics should be initiated 1
- Antibiotics should target common skin flora, particularly Staphylococcus aureus, which is a common causative organism 1, 3
- Milk cultures should be considered to guide antibiotic therapy in cases that don't respond to initial treatment 1
Antibiotic Selection
- Although evidence from randomized controlled trials is limited, antibiotics effective against Staphylococcus aureus are typically used 3
- Common antibiotic choices include:
- Dicloxacillin
- Flucloxacillin
- Cephalexin
- Amoxicillin-clavulanate 1
Management of Complications
- Approximately 10% of mastitis cases progress to breast abscesses, which require drainage 2
- Breastfeeding can continue on the affected side as long as the infant's mouth does not contact purulent drainage from the breast 2
- Ultrasonography should be performed to identify abscesses in immunocompromised patients or those with worsening or recurrent symptoms 1
Special Considerations
- Most patients can be treated as outpatients with oral antibiotics 1
- If the condition worsens or there is concern for sepsis, intravenous antibiotics and hospital admission may be required 1
- Factors that increase the risk of mastitis include overstimulation of milk production and tissue trauma 1
Prevention Strategies
- The best prevention is proper lactation technique, including a good infant latch 1
- Encourage physiologic breastfeeding rather than pumping when possible 1
- Avoid practices that may worsen the condition, such as:
- Excessive pumping to empty the breast
- Heat application
- Aggressive breast massage 1
Common Pitfalls to Avoid
- Discontinuing breastfeeding during mastitis treatment, which can actually worsen the condition 2
- Overuse of antibiotics for mild cases that could resolve with conservative measures 1, 3
- Excessive pumping and breast massage, which can cause tissue trauma and worsen inflammation 1
- Delaying treatment of non-responsive cases, which may lead to abscess formation 2