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, and drainage of any abscesses that may have formed. 1

Initial Management

• Continued breastfeeding or milk expression is essential and should be encouraged even during treatment as it helps with milk removal, which is a crucial part of recovery 1, 2
• A 1-2 day trial of conservative measures should be attempted first, including:
  • NSAIDs for pain and inflammation 2
  • Ice application to reduce inflammation 2
  • Feeding the infant directly from the affected breast 1, 3
  • Minimizing excessive pumping (which can worsen the condition) 2

Antibiotic Therapy

• If symptoms do not improve after 1-2 days of conservative management, antibiotic therapy should be initiated 2
• First-line antibiotics should target Staphylococcus aureus:
  • Dicloxacillin or cloxacillin are recommended as first-line treatments 3, 4
  • Cephalexin is an alternative option 4
• Antibiotics should be narrow-spectrum to cover common skin flora (Staphylococcus, Streptococcus) 2
• Milk culture may be necessary to determine the infecting organism and its antibiotic sensitivity, especially in cases that don't respond to initial therapy 3

Management of Complications

• Approximately 10% of mastitis cases progress to breast abscess formation 4
• If an abscess forms, drainage is required either through surgical drainage or needle aspiration 4
• Breastfeeding can continue even with an abscess, provided the infant's mouth does not contact purulent drainage 1, 4

Important Considerations

• Discontinuing breastfeeding during mastitis treatment can worsen the condition 1, 5
• The transfer of dicloxacillin/cloxacillin to breast milk is minimal and does not pose a risk to the infant 3
• As methicillin-resistant S. aureus (MRSA) becomes more common, it may be a more frequent cause of mastitis, requiring different antibiotic choices 4
• Factors that increase the risk of mastitis include overstimulation of milk production and tissue trauma from aggressive breast massage 2

When to Consider Hospitalization

• Most patients can be treated as outpatients with oral antibiotics 2
• Inpatient treatment should be considered if:
  • Symptoms worsen despite oral antibiotics 2
  • There are signs of sepsis 2
  • The patient is immunocompromised 2
  • Intravenous antibiotics are required 2

Prevention

• Proper lactation technique, including a good infant latch, is the best prevention 2
• Encourage physiologic breastfeeding rather than pumping when possible 2
• Avoid practices that may worsen the condition:
  • Excessive pumping to empty the breast 2
  • Heat application 2
  • Aggressive breast massage 2

Despite the common use of antibiotics in mastitis treatment, it's worth noting that a Cochrane review found insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for lactational mastitis, highlighting the need for more high-quality research in this area 6.