What is the treatment for mastitis?

Treatment of Mastitis

The treatment of mastitis should begin with conservative measures including continued breastfeeding, NSAIDs, ice application, and proper breastfeeding technique for 1-2 days, followed by antibiotics effective against Staphylococcus aureus if symptoms persist. 1

Initial Management

• Continued breastfeeding or milk expression is essential for treatment of mastitis and should be encouraged 2
• Conservative measures should be tried first for 1-2 days, including:
  • NSAIDs for pain and inflammation 1
  • Ice application to reduce inflammation 1
  • Feeding directly from the affected breast 1
  • Minimizing excessive pumping 1

Antibiotic Therapy

• If symptoms do not improve after 1-2 days of conservative management, antibiotics should be initiated 1
• First-line antibiotics should target common skin flora (Staphylococcus, Streptococcus) 1
• Preferred antibiotics include:
  • Dicloxacillin or cephalexin 3
  • Consider coverage for methicillin-resistant S. aureus (MRSA) in areas with high prevalence 3
• Antibiotic therapy should be continued for 10-14 days to prevent recurrence 1

Prevention of Complications

• Approximately 10% of mastitis cases progress to breast abscesses if not properly treated 2
• Warning signs requiring immediate medical attention include:
  • Worsening symptoms despite antibiotics 1
  • Development of a fluctuant mass 3
  • Systemic signs of sepsis 1
• Ultrasonography should be performed to identify abscesses in:
  • Immunocompromised patients 1
  • Patients with worsening or recurrent symptoms 1
• If an abscess forms, drainage is required through:
  • Needle aspiration (preferred if possible) 3
  • Surgical drainage for larger abscesses 3

Special Considerations

• Breastfeeding can and should continue even in the presence of mastitis and treated abscesses 3
• Breastfeeding from the affected breast is safe as long as the infant's mouth does not contact purulent drainage 2
• Avoid practices that may worsen mastitis:
  • Excessive pumping to empty the breast 1
  • Aggressive breast massage 1
  • Heat application 1
• Candida infection may develop as a complication of antibiotic therapy and requires antifungal treatment 4, 5

Prevention of Mastitis

• Proper lactation technique is the best prevention strategy 1
• Ensure good infant latch to prevent nipple trauma 3
• Encourage physiologic breastfeeding rather than pumping when possible 1
• Avoid overstimulation of milk production 1

Evidence Limitations

• There is insufficient high-quality evidence to definitively confirm the effectiveness of antibiotic therapy for lactational mastitis 6
• Current treatment recommendations are based primarily on clinical experience and observational studies rather than large randomized controlled trials 6