What is the treatment for mastitis?

Treatment for Mastitis

The primary treatment for lactational mastitis is to continue breastfeeding or expressing milk from the affected breast, along with appropriate antibiotic therapy if bacterial infection is suspected. 1

Initial Management

• Continue breastfeeding or milk expression from the affected breast, as this is essential for treatment and recovery 1, 2
• Apply warm compresses to the affected area before feeding to help with milk flow and reduce pain 2
• Ensure proper positioning and attachment of the baby at the breast to prevent milk stasis 3
• Use cold packs after feeding to reduce pain and inflammation 2
• Take pain medication such as ibuprofen to manage discomfort and reduce inflammation 3

Antibiotic Therapy

• If symptoms do not improve within 24 hours of supportive measures, antibiotic therapy should be initiated 4
• For suspected bacterial mastitis, antibiotics effective against Staphylococcus aureus are recommended, as this is the most common causative organism 3, 5
• First-line antibiotic choices include:
  • Dicloxacillin or cloxacillin (minimal transfer to breast milk) 5
  • Cephalosporins can also be effective for bacterial mastitis 4
• Antibiotic therapy should typically continue for 10-14 days to prevent recurrence 2

Management of Complications

• Approximately 10% of mastitis cases progress to breast abscesses, requiring drainage 1
• If an abscess forms:
  • Needle aspiration under antibiotic coverage is preferred when possible 4
  • Surgical drainage is reserved for cases where needle aspiration is not feasible 4
• Breastfeeding can continue on the affected side even with an abscess, as long as the infant's mouth does not contact purulent drainage 1

Important Considerations

• Delaying treatment of non-responsive mastitis may lead to abscess formation 1
• Discontinuing breastfeeding during mastitis treatment can worsen the condition 1, 2
• If antibiotics are prescribed, monitor for potential candida infection as a complication of antibiotic therapy 2
• For candida infections secondary to antibiotic use, nystatin is the treatment of choice 4

Evidence Quality Considerations

• While antibiotics are commonly prescribed, there is insufficient high-quality evidence from randomized controlled trials to definitively confirm their effectiveness for all cases of mastitis 3
• However, clinical practice guidelines and expert consensus support antibiotic use when symptoms do not improve with supportive measures alone 2, 4, 5