What is the treatment for an infected milk duct (mastitis)?

Treatment of Mastitis (Infected Milk Duct)

The first-line treatment for mastitis is dicloxacillin 500 mg orally four times daily for 7-14 days, along with continued breastfeeding and supportive measures to ensure complete breast emptying. 1, 2

Diagnosis and Initial Management

• Mastitis is diagnosed clinically based on symptoms including fever, malaise, focal breast tenderness, and overlying skin erythema, without requiring laboratory tests or imaging 2
• Initial conservative measures (1-2 days) should include:
  • Continued breastfeeding from the affected breast to ensure milk drainage 1, 2
  • NSAIDs for pain and inflammation 2
  • Ice application to reduce inflammation 2
  • Proper positioning of the infant at the breast to ensure effective milk removal 1, 3

Antibiotic Therapy

If symptoms do not improve after 1-2 days of conservative measures, antibiotic therapy should be initiated:

First-line antibiotics:

• Dicloxacillin 500 mg orally four times daily for 7-14 days 1, 4
• Cephalexin 500 mg orally four times daily for 7-14 days (alternative) 1

For penicillin-allergic patients:

• Clindamycin 300-450 mg orally every 6 hours for 7-14 days 5, 6

Important considerations:

• Antibiotics should target Staphylococcus aureus, the most common causative organism 1, 6
• Dicloxacillin has minimal transfer into breast milk (relative infant dose of only 0.03%), making it safe during breastfeeding 7
• Milk cultures should be considered in cases of recurrent or severe mastitis to guide antibiotic selection 2

Continued Breastfeeding

• Breastfeeding should continue during treatment as it helps with breast emptying and does not pose a risk to the infant 1, 6
• Frequent, complete emptying of the breast is essential for recovery and prevents complications 1, 2
• If direct breastfeeding is too painful, expressing milk manually or with a pump is recommended to maintain milk flow 2

Prevention of Complications

• Breast abscess is the most common complication of mastitis 1
• Early treatment of mastitis and continued breastfeeding help prevent abscess formation 1
• If symptoms worsen despite antibiotics, ultrasound should be performed to rule out abscess 2
• If an abscess develops, surgical drainage or needle aspiration is required, but breastfeeding can usually continue 1

Prevention of Recurrence

• Optimize breastfeeding technique with proper latch and positioning 1, 2
• Address any nipple soreness or damage promptly as these can precipitate mastitis 1
• Avoid practices that may worsen mastitis:
  • Excessive pumping to empty the breast 2
  • Aggressive breast massage 2
  • Overproduction of milk 2

When to Consider Hospitalization

• Worsening symptoms despite oral antibiotics 2
• Signs of sepsis 2
• Immunocompromised patient 2
• Need for intravenous antibiotics 2

Common Pitfalls to Avoid

• Discontinuing breastfeeding during mastitis treatment (this can worsen the condition) 1, 6
• Delaying antibiotic therapy when conservative measures fail 2
• Using heat application and aggressive breast massage (these may worsen inflammation) 2
• Failing to consider MRSA in recurrent or non-responsive cases 1