What is the treatment for mastitis?

Treatment of Mastitis

The primary 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

First-Line Management

• Continued breastfeeding or milk expression is essential for treatment, as regular emptying of the breast helps resolve the condition 1
• Breastfeeding should continue even on the affected side, including when an abscess has formed (provided the infant's mouth does not contact purulent drainage) 1
• Initial conservative measures for 1-2 days include:
  • Nonsteroidal anti-inflammatory drugs for pain management 3
  • Ice application to reduce inflammation 3
  • Feeding directly from the breast 3
  • Minimizing excessive pumping 3

Antibiotic Therapy

• If symptoms don't improve after 1-2 days of conservative measures, antibiotics should be initiated 3
• First-line antibiotics should target Staphylococcus aureus, with dicloxacillin or cephalexin being preferred options 2
• Milk cultures should be considered to guide antibiotic therapy, especially in cases not responding to initial treatment 3
• Antibiotics effective against methicillin-resistant S. aureus (MRSA) may be necessary as this organism becomes more common 2

Dicloxacillin Administration Notes:

• Should be taken with at least 4 fluid ounces (120 mL) of water 4
• Should NOT be taken in the supine position or immediately before going to bed to avoid esophageal irritation 4
• Transfer of dicloxacillin to breast milk is minimal, making it safe during breastfeeding 5

Management of Complications

• Approximately 10% of mastitis cases progress to breast abscesses 1, 2
• If an abscess forms, surgical drainage or needle aspiration is required 2
• Ultrasonography should be performed to identify abscesses in:
  • Immunocompromised patients 3
  • Patients with worsening symptoms 3
  • Cases of recurrent mastitis 3

Inpatient Management

• Most patients can be treated as outpatients with oral antibiotics 3
• Hospitalization with intravenous antibiotics is indicated when:
  • Symptoms worsen despite oral antibiotics 3
  • There are signs of sepsis 3
  • Patient has severe systemic symptoms 1

Prevention Strategies

• Proper lactation technique, including ensuring a good infant latch 3
• Encouraging physiologic breastfeeding rather than pumping when possible 3
• Avoiding factors that increase risk:
  • Overstimulation of milk production 3
  • Tissue trauma from aggressive breast massage 3
  • Excessive pumping to empty the breast 3
  • Excessive heat application 3

Important Cautions

• Discontinuing breastfeeding during mastitis treatment can worsen the condition 1
• Delaying treatment of non-responsive cases may lead to abscess formation 1
• Contrary to older practices, excessive breast massage, heat application, and aggressive emptying are no longer recommended as they may worsen inflammation 3
• Monitor for candida infection, which may develop as a complication of antibiotic therapy 6