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Lactational mastitis (inflammation of the breast in individuals who are lactating) affects up to 20% of breastfeeding individuals. It is characterized by localized breast pain with erythema, edema, and systemic symptoms such as fever/chills and malaise. Supportive treatment measures include the use of NSAIDS, heat and/or ice, and continued feeding or emptying of the breast (stagnant milk can allow for progression of infection). If there is no response to supportive measures within 24 hours, pursuing antibiotic therapy is appropriate. Staphylococcus and Streptococcus species are common organisms responsible for bacterial mastitis; first-line treatment options include Dicloxacillin 500 mg QID or Cephalexin 500 mg QID for 10-14 days. If there is a concern for MRSA, Clindamycin or Bactrim may be used but are considered second-line. Bactrim should be avoided in breastfeeding individuals with infants <1 month or infants who are jaundiced or premature.
Complications of mastitis can include early termination of breastfeeding, breast abscess, and systemic infection if untreated. Ultrasound can be used to assess for breast abscess in patients who do not respond appropriately to antibiotics.
References
Louis-Jacques AF, Berwick M, Mitchell KB. Risk Factors, Symptoms, and Treatment of Lactational Mastitis. JAMA. 2023;329(7):588–589. doi:10.1001/jama.2023.0004
Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022
Katrina B. Mitchell, Helen M. Johnson, Juan Miguel Rodríguez, Anne Eglash, Charlotte Scherzinger, Kyle Widmer, Pamela Berens, Brooke Miller, and the Academy of Breastfeeding Medicine. Breastfeeding Medicine 2022 17:5, 360-376