From the Guidelines
Antibiotics are recommended for the treatment of mastitis when symptoms persist or worsen after 12-24 hours of supportive care, or if there is evidence of a bacterial infection, such as Staphylococcus aureus or Streptococcus species 1.
Key Considerations
- For lactational mastitis, a 10-14 day course of dicloxacillin (500mg orally every 6 hours) or cephalexin (500mg orally every 6 hours) is typically prescribed 1.
- For non-lactational mastitis, a 7-10 day course of ciprofloxacin (500mg orally every 12 hours) or amoxicillin-clavulanate (875mg/125mg orally every 12 hours) may be used 1.
- In severe cases, hospitalization and intravenous antibiotics, such as oxacillin (1-2g every 4-6 hours) or vancomycin (1g every 12 hours), may be necessary 1.
Important Factors
- The decision to administer antibiotics should be based on the presence or absence of systemic inflammatory response syndrome (SIRS), such as temperature >38°C or <36°C, tachypnea >24 breaths per minute, tachycardia >90 beats per minute, or white blood cell count >12 000 or <400 cells/µL 1.
- Antibiotics active against MRSA are recommended for patients with carbuncles or abscesses who have failed initial antibiotic treatment or have markedly impaired host defenses or in patients with SIRS and hypotension 1.
- Clindamycin, linezolid, and daptomycin are alternative options for the treatment of MRSA infections 1.
From the Research
Use of Antibiotics in Mastitis
- The use of antibiotics in mastitis is a common practice, but the decision to use them should be based on the severity of the infection and the type of bacteria causing it 2, 3.
- In cases of mild mastitis, antibiotics may not be necessary, and treatment with other medications such as bromocriptine may be effective 4.
- However, in cases of severe mastitis or mastitis caused by certain types of bacteria, such as Staphylococcus aureus or Escherichia coli, antibiotics may be necessary to prevent the spread of the infection and promote healing 2, 3.
- The choice of antibiotic should be based on the type of bacteria causing the infection and the severity of the infection, as well as the potential for antibiotic resistance 5.
Factors to Consider When Using Antibiotics
- The potential for antibiotic resistance is a major concern when using antibiotics to treat mastitis, and the use of broad-spectrum antibiotics should be avoided whenever possible 5.
- The use of antibiotics in combination with other medications, such as corticosteroids, may be effective in reducing the severity of the infection and promoting healing 3.
- The duration of antibiotic treatment should be based on the severity of the infection and the response to treatment, and should be as short as possible to minimize the risk of antibiotic resistance 6.
Types of Antibiotics Used
- Cephapirin and cefapirin are commonly used antibiotics for the treatment of mastitis caused by Staphylococcus aureus and Escherichia coli 2, 3.
- Penicillin and ampicillin may be effective against Lactococcus garvieae, a type of bacteria that can cause mastitis in cows 5.
- The use of oral antibiotics, such as ciprofloxacin and co-amoxiclav, may be effective in treating mastitis in some cases, but the decision to use them should be based on the severity of the infection and the potential for antibiotic resistance 6.