Mastitis is painful inflammation of the breast, usually accompanied by infection.
Fever that occurs several weeks after the start of breastfeeding is frequently due to mastitis. Staphylococcal species are the most common causes.
Breast abscesses are very rare and occasionally caused by methicillin-resistant Staphylococcus aureus.
Symptoms and Signs of Mastitis
Mastitis symptoms may include high fever and breast symptoms: erythema, induration, tenderness, pain, swelling, and warmth to the touch. Mastitis is different from the pain and cracking of nipples that frequently accompanies the first days of breastfeeding.
Diagnosis of Mastitis
History and physical examination
Diagnosis of mastitis is by history and physical examination. Mastitis must be differentiated from breast engorgement without inflammation or infection.
Treatment of Mastitis
Analgesics
Complete emptying of breast milk
Antistaphylococcal antibiotics
Initial therapy is to manage pain and swelling with analgesics (acetaminophen or nonsteroidal anti-inflammatory drugs [NSAIDs]). To completely empty the breast of milk, warm compresses can be applied to the breast prior to or during breastfeeding or pumping. Fluid intake is encouraged. These measures are sufficient to treat many cases of mild or moderate mastitis.
Mastitis that does not respond to conservative measures or manifests as severe (eg, progressive erythema, signs of systemic illness) is treated with antibiotics aimed at Staphylococcus aureus, the most common causative pathogen (1). Examples are
Dicloxacillin 500 mg orally every 6 hours for 7 to 10 days
For women allergic to penicillin, cephalexin 500 mg orally 4 times a day or clindamycin 300 mg orally 3 times a day for 10 to 14 days
Erythromycin 250 mg orally every 6 hours is used less frequently.
If women do not improve and do not have an abscess, vancomycin 1 g IV every 12 hours or cefotetan 1 to 2 g IV every 12 hours to cover resistant organisms should be considered. Breastfeeding and/or pumping should be continued during treatment because treatment includes emptying the affected breast.
Breast abscesses are diagnosed by ultrasound and are treated mainly with drainage via needle aspiration or surgical incision. Antibiotics aimed at S. aureus are often used.
It is not clear whether antibiotics aimed at methicillin-resistant S. aureus are necessary for treatment of mastitis or breast abscess. In rare situations when there is no abscess and the patient is not improving with antibiotics, milk culture can be done.
Довідковий матеріал щодо лікування
1. Breastfeeding Challenges: ACOG Committee Opinion Summary, Number 820. Obstet Gynecol. 2021 Feb 1;137(2):394-395. doi: 10.1097/AOG.0000000000004254.
