mastitis
MASTITIS
Mastitis is the inflammation of the breast that may or may not be associated with bacterial infection.
Staphylococcus aureus is the most common organism associated with mastitis.
It may occur spontaneously or during lactation. It most frequently occurs during the first 6-8 weeks postpartum, although it may occur any time during breastfeeding.
Nonpuerperal mastitis is most commonly associated with breast cyst.
Breast abscess (collection of pus in the breast) is a complication of mastitis.

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
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