Lactational mastitis
Acute mastitis is usually associated with breastfeeding and is often caused by Staphylococcus aureus. Poor infant positioning, milk stasis and nipple damage are contributing factors. Breastfeeding or expressing milk (manually or via a pump) from the infected breast is safe and should be continued.
If mastitis is not associated with breastfeeding, seek expert advice for management.
In patients without systemic symptoms, increased breastfeeding and gently expressing milk from the affected breast may prevent progression and resolve infection without antibiotics.
In patients with systemic symptoms, or symptoms or signs that have not resolved after 24 to 48 hours of increased breastfeeding and expressing of milk, early antibiotic therapy is important to prevent abscess formation. Combine antibiotic therapy with increased breastfeeding and expressing of milk.
Use:
1 dicloxacillin 500 mg orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see dicloxacillin dosage adjustment. If symptoms and signs resolve rapidly, 5 days of therapy may be sufficient; otherwise continue treatment for 10 days lactational mastitis dicloxacillin
OR
1 flucloxacillin 500 mg orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see flucloxacillin oral dosage adjustment. If symptoms and signs resolve rapidly, 5 days of therapy may be sufficient; otherwise continue treatment for 10 days. lactational mastitis flucloxacillin
For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin1, use:
cefalexin 500 mg orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see cefalexin dosage adjustment. If symptoms and signs resolve rapidly, 5 days of therapy may be sufficient; otherwise continue treatment for 10 days. lactational mastitis cefalexin
For patients who have had a severe (immediate or delayed)2 hypersensitivity reaction to a penicillin, use:
clindamycin 450 mg orally, 8-hourly. If symptoms and signs resolve rapidly, 5 days of therapy may be sufficient; otherwise continue treatment for 10 days. lactational mastitis clindamycin
If infection does not resolve with antibiotic therapy, evaluate the patient for an abscess and consider whether infection is caused by another pathogen.
If the patient has severe cellulitis, see Cellulitis associated with systemic features for initial treatment. Switch to oral therapy (as above) when symptoms are resolving.