There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
Management of Mastitis
The management of mastitis typically involves a combination of conservative measures and antibiotic therapy. Some key points to consider include:
- Diagnosis is usually made clinically based on symptoms such as fever, malaise, focal breast tenderness, and overlying skin erythema or hyperpigmentation 1
- Conservative measures such as nonsteroidal anti-inflammatory drugs, ice application, feeding the infant directly from the breast, and minimizing pumping may be sufficient for treatment in some cases 1
- If symptoms do not improve, narrow-spectrum antibiotics may be prescribed to cover common skin flora (e.g., Staphylococcus, Streptococcus) 1, 2, 3
- Effective milk removal is recommended as a first step in mastitis management, and active emptying of the breasts can prevent mastitis development in most cases 4
- Continued breastfeeding is generally encouraged in the presence of mastitis and does not pose a risk to the infant 1, 3
Antibiotic Therapy
Antibiotic therapy is often used to treat mastitis, particularly if symptoms do not improve with conservative measures. Some points to consider include:
- Antibiotics effective against Staphylococcus aureus (e.g., dicloxacillin, cephalexin) are preferred 2, 3
- The use of antibiotics with temporary suppression of breastfeeding may be more effective than with continuing breastfeeding in some cases 4
- However, there is insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for the treatment of lactational mastitis 2
Alternative Therapies
Some alternative therapies have been suggested for the management of mastitis, including:
- Osteopathic manipulative treatment (OMT) may be effective in managing recurrent lactational mastitis, although further research is needed to confirm this 5
- Progesterone-containing gel may be effective in reducing engorgement and tenderness in heavy breast engorgement, and may also be used to prevent mastitis 4