Oral Treatment Options for Mastitis

Dicloxacillin is the preferred oral antibiotic for treating mastitis, with a recommended dosage of 500 mg every 6 hours for 7-14 days. 1, 2

First-Line Oral Antibiotic Options

Dicloxacillin 500 mg orally every 6 hours (250 mg every 6 hours for mild cases) is the first-line treatment for mastitis that doesn't respond to conservative measures 1, 2
Cephalexin is an alternative first-line agent effective against Staphylococcus aureus, which is the most common bacterial cause of mastitis 2
Oral antibiotics should be taken on an empty stomach, at least 1 hour before or 2 hours after meals, with at least 4 fluid ounces (120 mL) of water 1

A 1-2 day trial of conservative measures is often sufficient before initiating antibiotics, as most cases of mastitis are inflammatory rather than infectious 3
Conservative measures include:
- Nonsteroidal anti-inflammatory drugs for pain and inflammation 3
- Ice application to reduce inflammation 3
- Continued breastfeeding directly from the affected breast 3, 2
- Minimizing pumping (contrary to previous recommendations of aggressive emptying) 3

Antibiotics should be initiated if no improvement is seen after 24-48 hours of conservative measures 3
Antibiotics that are effective against Staphylococcus aureus should be selected 2
The full course of antibiotic therapy should be completed even if symptoms improve quickly 1

As methicillin-resistant S. aureus (MRSA) becomes more common, it may become a more frequent cause of mastitis 2
In cases of suspected or confirmed MRSA, alternative antibiotics effective against this organism should be considered 2

Antibiotic therapy should typically continue for 7-14 days 1, 2
For severe staphylococcal infections, therapy should continue for at least 14 days 1
Treatment should continue for at least 48 hours after the patient becomes afebrile and asymptomatic 1

Breast abscess is the most common complication of mastitis and can be prevented by early treatment and continued breastfeeding 2
If symptoms worsen despite oral antibiotics, consider:
- Obtaining milk cultures to guide antibiotic therapy 3
- Ultrasonography to identify potential abscesses, especially in immunocompromised patients or those with worsening/recurrent symptoms 3
- Possible need for intravenous antibiotics and hospital admission if condition deteriorates or there is concern for sepsis 3

Continued breastfeeding is encouraged during mastitis treatment and generally does not pose a risk to the infant 2
Proper lactation technique, including a good infant latch, is essential for both treatment and prevention 3
Encouraging physiologic breastfeeding rather than pumping is recommended when possible 3

Patients with severe illness, nausea, vomiting, gastric dilation, cardiospasm, or intestinal hypermotility may not adequately absorb oral antibiotics 1
Penicillin-class antibiotics should be used with caution in individuals with histories of significant allergies or asthma 1
Patients should be monitored for allergic reactions and advised to stop the medication and notify their physician if they experience shortness of breath, wheezing, skin rash, or other concerning symptoms 1