Mastitis Treatment
Pharmacotherapy
- 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
Non-Pharmacological Therapy
- 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