What is the treatment for mastitis?

Treatment for Mastitis

The essential treatment for lactational mastitis includes continued breastfeeding or milk expression from the affected breast, along with appropriate antibiotic therapy when indicated. 1

Initial Management

• Continued breastfeeding or milk expression is the cornerstone of mastitis treatment, as effective milk removal is essential and discontinuing breastfeeding can worsen the condition 1, 2
• Proper positioning of the baby at the breast should be ensured to prevent milk stasis, which can contribute to mastitis 3
• Supportive measures include:
  • Pain medication for symptom relief 3
  • Application of warm compresses to the affected breast before feeding to facilitate milk flow 2
  • Adequate rest and hydration to support recovery 2

Antibiotic Therapy

• Antibiotic therapy should be initiated when there are significant inflammatory symptoms or systemic involvement (fever, significant pain) 3
• Staphylococcus aureus is the most common causative organism in bacterial mastitis 3, 4
• First-line antibiotic recommendations:
  • Dicloxacillin or cloxacillin are recommended as first-line antibiotics due to their effectiveness against Staphylococcus aureus and minimal transfer to breast milk 4
  • These antibiotics are effective against beta-lactamase producing Staphylococcus aureus, which is commonly resistant to other antibiotics 4

Management of Complications

• Approximately 10% of mastitis cases progress to breast abscesses if not properly treated 1
• Breast abscesses require drainage, but breastfeeding can continue on the affected side as long as the infant's mouth does not contact purulent drainage 1
• Milk culture may be necessary to determine the infecting organism and its antibiotic sensitivity, especially in cases not responding to initial therapy 4

Important Considerations

• Delaying treatment of non-responsive cases may lead to abscess formation 1
• Candida infection may develop as a result of antibiotic therapy and may require specific antifungal treatment 2
• Improperly treated mastitis may lead to premature cessation of breastfeeding, affecting both mother and baby 2

Evidence Quality Considerations

• While continued breastfeeding and effective milk removal are universally recommended, the evidence for antibiotic therapy is less robust 3
• A Cochrane review found insufficient high-quality evidence to definitively confirm or refute the effectiveness of antibiotic therapy for lactational mastitis, highlighting the need for more rigorous studies 3
• Despite limited evidence, clinical practice guidelines from the American Academy of Pediatrics support the use of antibiotics when indicated by severity of symptoms 1