What is the treatment for mastitis (inflammation of the breast tissue)?

From the Guidelines

Mastitis treatment should involve a combination of antibiotics, pain management, and continued breastfeeding or milk expression, with the goal of reducing morbidity, mortality, and improving quality of life. The most recent and highest quality study 1 recommends that mothers with mastitis are encouraged to continue to breastfeed, as regular feeding or expression of milk is an adjunct to other treatment. For mild mastitis, dicloxacillin or cephalexin 500mg four times daily for 10-14 days is recommended, while for more severe cases or those with MRSA concerns, clindamycin 300mg four times daily may be used 1.

Key Considerations

• Continue to empty the affected breast completely through breastfeeding or pumping every 2-3 hours to help clear the infection and prevent milk stasis.
• Apply warm compresses before feeding and cold packs after to reduce pain and swelling.
• Take ibuprofen 400-600mg every 6 hours as needed for pain and inflammation.
• Ensure proper latch if breastfeeding and consider consulting a lactation specialist to address underlying issues.
• Adequate rest, hydration, and wearing a supportive but non-restrictive bra can aid recovery.

Potential Complications

• Approximately 10% of mastitis cases progress to breast abscesses, which require drainage.
• If symptoms worsen or don't improve within 48 hours, seek medical attention as this may indicate an abscess requiring drainage.

Breastfeeding and Mastitis

• Breastfeeding can continue on the affected side as long as the infant’s mouth does not contact purulent material.
• The American Academy of Pediatrics recommends that mothers with mastitis are encouraged to continue to breastfeed, as the benefits of breastfeeding outweigh the risks of mastitis.

From the Research

Mastitis Treatment Overview

• Mastitis is an infection that occurs in approximately 10 percent of U.S. mothers who are breastfeeding, and it can lead to the cessation of breastfeeding 2.
• The risk of mastitis can be reduced by frequent, complete emptying of the breast and by optimizing breastfeeding technique 2.
• Treatment includes changing breastfeeding technique, often with the assistance of a lactation consultant, and when antibiotics are needed, those effective against Staphylococcus aureus (e.g., dicloxacillin, cephalexin) are preferred 2, 3.

Antibiotic Therapy

• Effective milk removal, pain medication, and antibiotic therapy have been the mainstays of treatment for mastitis 4.
• There is insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for the treatment of lactational mastitis 4.
• When antibiotics are warranted, dicloxacillin or cloxacillin are suggested as first-line drugs, and the transfer of these antibiotics to breast milk is minimal 3.

Methicillin-Resistant Staphylococcus aureus (MRSA)

• The incidence of mastitis caused by MRSA is unknown, but likely increasing 5.
• Recent evidence suggests that MRSA has become the prominent pathogen in mastitis, and physicians caring for patients with mastitis need to be aware of this bacteriologic shift to treat appropriately 5.
• MRSA strains have been found in both human and bovine mastitis, and the emergence of MRSA in dairy cattle may be associated with contact with other host species or with the exchange of genetic material between S. aureus and coagulase-negative Staphylococcus species 6.

Continued Breastfeeding

• Continued breastfeeding should be encouraged in the presence of mastitis and generally does not pose a risk to the infant 2.
• Breastfeeding can usually continue in the presence of a treated abscess, and early treatment of mastitis and continued breastfeeding can prevent breast abscess 2.