Medical Management of Mastitis
Continue breastfeeding or milk expression combined with conservative measures for 12-24 hours, then initiate antibiotics targeting Staphylococcus aureus if symptoms persist or worsen. 1, 2
Initial Conservative Management (First 12-24 Hours)
Most mastitis cases are inflammatory rather than infectious, so start with conservative measures before antibiotics. 2
- Continue breastfeeding or milk expression frequently from the affected breast—this is essential for treatment and should never be discontinued unless purulent drainage contacts the infant's mouth 1, 3
- Administer NSAIDs for pain and inflammation control 1, 2
- Apply ice to reduce inflammation 2
- Feed the infant directly from the breast rather than pumping when possible 2
- Minimize pumping as overstimulation can worsen the condition 2
Critical Pitfall to Avoid
Do NOT use heat application, aggressive breast massage, or excessive pumping to "empty the breast"—these outdated practices increase tissue trauma and milk production, worsening mastitis 2. This contradicts older recommendations but reflects current best evidence.
Antibiotic Therapy (If No Improvement After 12-24 Hours)
Initiate narrow-spectrum antibiotics effective against Staphylococcus aureus if conservative measures fail 1, 2:
- First-line options: Dicloxacillin or cephalexin 3
- Consider obtaining milk cultures to guide antibiotic selection, particularly for recurrent or severe cases 2
- Be aware of MRSA: As methicillin-resistant S. aureus becomes more prevalent, antibiotics effective against this organism may be needed 3
Indications for Hospitalization
Admit patients with systemic involvement or complications 1:
- Fever with chills indicating systemic involvement 1
- Worsening symptoms despite outpatient management 1
- Concern for sepsis 1, 2
- Immunocompromised status 2
Inpatient Management Components
- Intravenous antibiotics targeting S. aureus 1, 2
- Continued breastfeeding or milk expression—provide breast pump if prolonged separation occurs 1
- Pain management with appropriate analgesics 1
- Access to trained breastfeeding support staff 1
Management of Abscess Formation
Approximately 10% of mastitis cases progress to breast abscess, requiring drainage 1, 3:
- Perform ultrasonography to identify abscesses in immunocompromised patients or those with worsening/recurrent symptoms 2
- Drainage required: Surgical drainage or needle aspiration 3, 4
- Breastfeeding can continue on the affected side as long as the infant's mouth does not contact purulent drainage 1, 3
- Early treatment prevents abscess formation—delays in treating non-responsive cases increase this risk 1
What NOT to Do
Avoid these common errors that worsen outcomes 2: