Treatment of Lactational Mastitis
Continue breastfeeding or milk expression on the affected breast while initiating antibiotic therapy targeting Staphylococcus aureus, specifically dicloxacillin or cephalexin as first-line agents. 1, 2
Immediate Management Steps
Continue Breastfeeding
- Regular feeding or milk expression from the affected breast is essential and must be encouraged even during active mastitis. 1, 2
- Breastfeeding can safely continue even if an abscess has formed, provided the infant's mouth does not contact purulent drainage from the breast. 1
- Discontinuing breastfeeding worsens the condition and increases risk of abscess formation. 1
- Effective milk removal is the most critical component of treatment and may make antibiotics unnecessary in some cases. 3
Antibiotic Therapy
- Dicloxacillin or cephalexin are the preferred first-line antibiotics, as they effectively target Staphylococcus aureus, the most common causative organism. 2, 3
- Dicloxacillin/cloxacillin transfer minimally into breast milk, making them safe during breastfeeding. 3
- As methicillin-resistant S. aureus (MRSA) becomes more prevalent, antibiotics effective against MRSA may become necessary if initial therapy fails. 2
- One small trial comparing amoxicillin with cephradine showed no significant difference, though evidence suggests faster symptom clearance with antibiotics versus supportive therapy alone. 4, 1
Supportive Care
- Provide appropriate analgesics for pain management, as pain can exacerbate symptoms. 1
- Address mechanical factors: optimize breastfeeding technique and latch, often requiring consultation with a lactation specialist. 2
- Ensure frequent, complete breast emptying to prevent milk stasis. 2
When to Hospitalize
Hospitalization is warranted when fever and chills indicate systemic involvement, or when there is concern for sepsis. 1
During hospitalization:
- Provide access to breast pumps if prolonged separation from infant occurs. 1
- Ensure availability of trained breastfeeding support staff. 1
- Schedule procedures to allow breastfeeding or milk expression as close to surgery as possible. 1
Management of Complications
Breast Abscess
- Approximately 10% of mastitis cases progress to breast abscess, which requires drainage via surgical intervention or needle aspiration. 1, 2
- Early treatment of mastitis and continued breastfeeding prevent abscess formation. 2
- Breastfeeding can continue on the affected side even with a treated abscess, as long as the infant's mouth avoids purulent drainage. 1, 2
Common Pitfalls to Avoid
- Never advise stopping breastfeeding during mastitis treatment—this is the most critical error and will worsen the condition. 1
- Do not delay antibiotic treatment when systemic symptoms are present, as this increases abscess risk. 1
- Milk culture is necessary to determine the infecting organism and antibiotic sensitivity when initial therapy fails. 3
- Address underlying causes such as poor latch, sore nipples, or infant mouth anomalies that precipitate mastitis. 2