What is the recommended treatment for inpatient mastitis?

Inpatient Treatment of Mastitis

The recommended inpatient treatment for mastitis includes continued breastfeeding or milk expression, appropriate antibiotic therapy targeting Staphylococcus aureus (such as dicloxacillin or cephalexin), and drainage of any abscesses that may have formed. 1, 2

Continued Breastfeeding/Milk Expression

• Regular feeding or expression of milk is an essential component of treatment for mastitis and should be encouraged to continue even during hospitalization 2, 3
• Discontinuing breastfeeding during mastitis treatment can worsen the condition and potentially lead to abscess formation 3
• Breastfeeding can continue on the affected side even if an abscess has formed, provided the infant's mouth does not contact purulent drainage from the breast 2

Antibiotic Therapy

• For inpatient treatment, antibiotics effective against Staphylococcus aureus are the preferred choice 1
• Recommended intravenous antibiotics include:
  • Dicloxacillin or cephalexin (first-line options) 1
  • Consider coverage for methicillin-resistant S. aureus (MRSA) if prevalent in your area or if initial treatment fails 1
• Obtain milk cultures to guide antibiotic therapy, especially in hospitalized patients with severe or non-responsive cases 4
• Duration of intravenous therapy is typically until clinical improvement, then transition to oral antibiotics to complete a 10-14 day course 4

Management of Complications

• Approximately 10% of mastitis cases progress to breast abscess formation, which is the most common complication 2, 1
• Breast abscesses require drainage through either surgical incision or needle aspiration 1
• Ultrasound should be performed to identify abscesses in patients with worsening or recurrent symptoms despite appropriate antibiotic therapy 4
• For severe cases with signs of sepsis, aggressive intravenous fluid resuscitation may be necessary in addition to antibiotics 4

Supportive Care

• Pain management with appropriate analgesics is essential, as pain can exacerbate symptoms 2
• Anti-inflammatory medications (NSAIDs) can help reduce inflammation and provide pain relief 4
• Ice application may provide symptomatic relief 4
• Avoid excessive heat application and aggressive breast massage as these may worsen inflammation 4

Discharge Planning

• Before discharge, ensure the patient has:
  • Appropriate oral antibiotics to complete the full course of therapy 4
  • Clear instructions on continued breastfeeding technique 5
  • Follow-up appointment scheduled to ensure resolution 5
  • Education on prevention of recurrence through proper breastfeeding technique 4

Special Considerations

• For patients with recurrent mastitis, consider underlying anatomical issues or resistant organisms 5
• If symptoms do not improve within 48-72 hours of appropriate inpatient therapy, reassess for abscess formation or resistant organisms 1, 4
• Lactation consultant involvement is highly recommended to optimize breastfeeding technique and prevent recurrence 1

By following this treatment approach, most patients with mastitis requiring hospitalization will improve rapidly and can be discharged to complete treatment as outpatients, with continued breastfeeding support to prevent recurrence.