What is the treatment for mastitis?

Treatment of Mastitis

The treatment of mastitis should focus on continued breastfeeding or milk expression as an essential part of management, combined with conservative measures and antibiotics when necessary. 1

Initial Management Approach

• Continued breastfeeding or milk expression is crucial for treatment, as regular and complete emptying of the breast helps resolve mastitis 1, 2
• A 1-2 day trial of conservative measures should be attempted first, including:
  • Nonsteroidal anti-inflammatory drugs for pain and inflammation 2
  • Ice application to reduce pain and swelling 2
  • Feeding the infant directly from the affected breast 2
  • Minimizing excessive pumping 2

Antibiotic Therapy

• If symptoms do not improve after 1-2 days of conservative management, antibiotics effective against Staphylococcus aureus should be initiated 3, 2
• First-line antibiotic options include:
  • Dicloxacillin or cloxacillin (minimal transfer to breast milk) 4
  • Cephalexin as an alternative option 3
• Milk cultures should be considered to guide antibiotic therapy, especially in cases that don't respond to initial treatment 2
• As methicillin-resistant S. aureus (MRSA) becomes more common, antibiotics effective against this organism may be needed in certain cases 3

Proper Breastfeeding Technique

• Optimizing breastfeeding technique is essential for both treatment and prevention of mastitis 3
• Consultation with a lactation consultant is recommended to ensure proper latch and feeding techniques 3
• Frequent, complete emptying of the breast reduces the risk of milk stasis, which can precipitate mastitis 3, 4

Management of Complications

• Approximately 10% of mastitis cases progress to breast abscesses 1
• If an abscess develops, surgical drainage or needle aspiration is required 3
• Breastfeeding can continue on the affected side even with an abscess, as long as the infant's mouth does not contact purulent drainage 1
• Ultrasonography should be performed to identify abscesses in immunocompromised patients or those with worsening or recurrent symptoms 2

Common Pitfalls to Avoid

• Discontinuing breastfeeding during mastitis treatment can worsen the condition and should be avoided 1
• Practices that were previously recommended but are now discouraged include:
  • Excessive pumping to empty the breast 2
  • Heat application 2
  • Aggressive breast massage 2
  • These interventions may worsen inflammation by overstimulating milk production and causing tissue trauma 2
• Delaying treatment of non-responsive cases may lead to abscess formation 1

Prevention Strategies

• The best prevention is proper lactation technique, including:
  • Ensuring a good infant latch 2
  • Encouraging physiologic breastfeeding rather than pumping when possible 2
  • Addressing sore nipples promptly, as they can precipitate mastitis 3