From the Guidelines
For mastitis, the recommended antibiotic treatment is erythromycin, as suggested by the most recent guidelines 1. The choice of antibiotic should target Staphylococcus aureus, the most common bacterial cause of mastitis. While treating with antibiotics, it is essential to continue breastfeeding or expressing milk from the affected breast to prevent milk stasis, which worsens inflammation. Apply warm compresses before feeding and take anti-inflammatory medications like ibuprofen 400-600 mg every 6 hours as needed for pain and inflammation. Adequate hydration and rest are also important for recovery. If symptoms don't improve within 48 hours of antibiotic therapy, or if there are signs of abscess formation (fluctuant mass), seek medical attention as drainage may be necessary. For recurrent mastitis, consider longer antibiotic courses and evaluation for anatomical issues or resistant organisms. It is crucial to note that mothers with mastitis are encouraged to continue breastfeeding, as regular feeding or expression of milk is an adjunct to other treatment, and antibiotics may be indicated 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Mastitis and Antibiotics
- Mastitis is a common infection in breastfeeding women, with a prevalence of up to 33% 2, 3.
- The most common cause of mastitis is Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA) 4, 5, 6.
- Antibiotics effective against S. aureus, such as dicloxacillin and cephalexin, are preferred for treatment 4.
- However, there is insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for the treatment of lactational mastitis 2, 3.
Antibiotic Treatment
- A small trial compared amoxicillin with cephradine and found no significant difference between the two antibiotics in terms of symptom relief and abscess formation 2, 3.
- Another study suggested faster clearance of symptoms for women using antibiotics, although the study design was problematic 2, 3.
- MRSA is increasingly causing mastitis, and physicians should be aware of this bacteriologic shift to treat appropriately 5, 6.
Breastfeeding and Mastitis
- Continued breastfeeding is encouraged in the presence of mastitis and generally does not pose a risk to the infant 4.
- Effective milk removal and pain medication are also important for treatment 2, 3.
- Hospitalization may be required more frequently in cases of MRSA, especially if the Panton-Valentine leukocidin toxin is present 6.