What is the treatment for postpartum mastitis?

Treatment of Postpartum Mastitis

The first-line treatment for postpartum mastitis includes continued breastfeeding or milk expression from the affected breast, supportive measures such as NSAIDs and ice application for 1-2 days, followed by antibiotics effective against Staphylococcus aureus (such as dicloxacillin or cephalexin) if symptoms persist. 1, 2

Diagnosis and Clinical Presentation

• Mastitis is diagnosed clinically based on symptoms including fever, malaise, focal breast tenderness, and overlying skin erythema or hyperpigmentation 1
• Laboratory tests or imaging are typically not needed for initial diagnosis in straightforward cases 1
• Approximately 10% of breastfeeding mothers in the United States develop mastitis, most commonly in the first 3 months postpartum 3, 1

Initial Management Approach

• Continue breastfeeding or milk expression from the affected breast as this is essential for treatment 2
• Begin with conservative measures for 1-2 days:
  • Nonsteroidal anti-inflammatory drugs for pain and inflammation 1
  • Ice application to reduce inflammation 1
  • Feed infant directly from the affected breast 1
  • Minimize excessive pumping as it may worsen the condition 1

Antibiotic Therapy

• If no improvement after 1-2 days of conservative measures, initiate antibiotics 1
• Choose antibiotics effective against Staphylococcus aureus:
  • First-line options: dicloxacillin or cephalexin 3
  • Consider coverage for methicillin-resistant S. aureus (MRSA) in areas with high prevalence 3
• Milk cultures should be considered to guide antibiotic therapy in cases that don't respond to initial treatment 1

Management of Complications

• Approximately 10% of mastitis cases progress to breast abscess 2
• If abscess is suspected (persistent symptoms despite antibiotics), obtain breast ultrasound 1
• Abscesses require drainage, either by surgical incision or needle aspiration 3
• Breastfeeding can continue on the affected side as long as the infant's mouth does not contact purulent drainage 2
• For worsening symptoms or concerns for sepsis, intravenous antibiotics and hospital admission may be required 1

Prevention Strategies

• Optimize breastfeeding technique, including proper infant latch 3, 1
• Encourage physiologic breastfeeding rather than pumping when possible 1
• Avoid practices that may worsen the condition:
  • Excessive pumping to empty the breast 1
  • Aggressive breast massage 1
  • Excessive heat application 1

Important Considerations

• Discontinuing breastfeeding during mastitis treatment can worsen the condition 2
• Delaying treatment of non-responsive cases may lead to abscess formation 2
• Consider consultation with a lactation specialist to optimize breastfeeding technique 3
• Candida infection may develop as a complication of antibiotic therapy and should be treated appropriately if diagnosed 4