What is the treatment for mastitis?

Treatment of Mastitis

Continue breastfeeding or milk expression on the affected breast while initiating a 1-2 day trial of conservative measures (NSAIDs and ice), then add narrow-spectrum antibiotics targeting Staphylococcus aureus (dicloxacillin or cephalexin) if symptoms do not improve. 1

Initial Conservative Management (First 1-2 Days)

Most mastitis cases result from inflammation rather than true infection, making conservative therapy the appropriate first-line approach 1:

• Apply ice to the affected breast and administer NSAIDs for pain and inflammation 1
• Feed the infant directly from the affected breast rather than pumping 1
• Minimize pumping frequency, as overstimulation worsens mastitis 1
• Avoid heat application and aggressive breast massage, as these increase tissue trauma and milk production, exacerbating the condition 1

Antibiotic Therapy

Initiate antibiotics only if symptoms fail to improve after 1-2 days of conservative management 1:

• First-line antibiotics: Dicloxacillin or cephalexin to cover Staphylococcus aureus and common skin flora 2, 1
• Consider obtaining milk cultures to guide therapy, particularly in immunocompromised patients or those with recurrent symptoms 1
• As methicillin-resistant S. aureus becomes more prevalent, antibiotics effective against MRSA may become necessary 2
• Most patients can be treated with oral antibiotics as outpatients 1

Continued Breastfeeding

Never discontinue breastfeeding during mastitis treatment, as this worsens the condition and increases abscess risk 3, 2:

• Regular feeding or milk expression is essential for treatment success 3
• Breastfeeding from the affected breast poses no risk to the infant 2
• Even if an abscess develops, breastfeeding can continue on the affected side provided the infant's mouth does not contact purulent drainage 3, 2
• Discontinuing breastfeeding can worsen mastitis and delay resolution 3

Inpatient Management Indications

Hospitalize patients with worsening symptoms, concern for sepsis, or inability to tolerate oral therapy 1:

• Administer intravenous antibiotics for severe cases 1
• Provide access to breast pumps if prolonged mother-infant separation occurs 3
• Ensure availability of trained breastfeeding support staff 3
• Schedule procedures to allow breastfeeding or milk expression as close to surgery as possible 3

Abscess Management

Approximately 10% of mastitis cases progress to breast abscess, requiring drainage 3, 2:

• Perform ultrasonography to identify abscesses in immunocompromised patients or those with worsening/recurrent symptoms 1
• Treat abscesses with surgical drainage or needle aspiration 2
• Early antibiotic treatment and continued breastfeeding prevent abscess formation 2
• Breastfeeding can continue even with a treated abscess, avoiding contact between the infant's mouth and purulent drainage 2

Common Pitfalls to Avoid

• Do not recommend excessive pumping to "empty the breast"—this overstimulates milk production and worsens inflammation 1
• Do not apply heat or perform aggressive breast massage—these cause tissue trauma 1
• Do not delay antibiotic therapy beyond 2 days if conservative measures fail—this increases abscess risk 3
• Probiotics lack sufficient evidence for treatment or prevention 1