Mastitis Treatment

• Assure patients that recommended medications are safe with breastfeeding

Symptomatic Therapy

• May give analgesics (eg Paracetamol) for pain
• Nonsteroidal anti-inflammatory drugs (eg Ibuprofen) may also be given
• As lactational mastitis may occur with traumatized nipples (eg cracked, abraded or fissured during breastfeeding), topical Mupirocin may be applied for superficial skin infection associated with skin trauma
  • This should be removed before and reapplied after each feeding

Antibiotic Therapy

General Principles

• Indicated when there is persistence of symptoms within 12-24 hours with non-pharmacological therapy or presence of moderate to severe symptoms
• Usual duration of antibiotic treatment is 10-14 days
• Improvement should be seen within 2-3 days of treatment
• Hospital admission is indicated in patients with systemic sepsis; parenteral (eg IV) antibiotics are necessary

Flucloxacillin or Dicloxacillin

• Given to patients with non-severe cases without risk factors for MRSA infection
• Dicloxacillin has lower rate of adverse hepatic effects compared to Flucloxacillin

First-Generation Cephalosporins

• Alternative for patients hypersensitive to penicillins
• Cephalexin may also be given to patients with non-severe cases without risk factors for MRSA infection

Clindamycin

• Alternative for patients with immediate hypersensitivity to penicillins or beta-lactams
• Effective against MRSA

Trimethoprim-Sulfamethoxazole

• Effective against MRSA

Vancomycin or Lincomycin

• Alternative for patients with serious allergy to penicillins and cephalosporins
• Empiric inpatient therapy given in severe infections

• Breastfeeding should be continued; mastitis is not an indication for early breastfeeding cessation
  
  • Sudden cessation of breastfeeding leads to a higher risk of abscess formation than continuing to feed

• Adequate rest, fluid intake, and nutrition are important supportive measures
• Effective drainage of breastmilk
  
  • This may be done through breastfeeding, expressing or massaging
  • Correct positioning and attachment
  • Frequent milk feeding (nurse on the normal breast and pump the involved breast)
  • Apply warm compress prior to feeding to assist with milk let-down reflex
  • Apply cold compress after milk feeding to reduce pain and edema
  • Fluid mobilization by stroking the skin from the areola to the axilla

• Patient needs to be informed about the nature of the infection
• Maternal handwashing before each feed and the use of antiseptic gels by hospital personnel reduce hospital-acquired infection rates (eg MRSA-associated mastitis)
• Psychological support through reassurance and evaluation for depression and anxiety
• Surgical referral for possible drainage or needle aspiration is necessary in cases of large or multiple breast abscesses