Breast infection
Management:
(Note: About 10-33% of lactating women develop mastitis, usually in the first 6 weeks post-partum, breast abscesses develop in 3-11% of women with mastitis)
Admission if:
- Signs of sepsis
- Rapid progression
- No improvement after 48 hours - risk of abscess formation
- Signs of abscess
Advised:
Paracetamol or ibuprofen.
Warm compress or warm shower
Avoid wearing a bra, especially at night
Mastitis in lactating women:
Continue milk flow:
- Breastfeeding is the best method of emptying the breast (including feeding from the affected side), but babies won't always feed
- Expressing milk if feeding not occurring or if breast not emptied, machine or hand
(Note: Most common organism is Staphylococcus aureus, but initially, cause may be inflammatory from milk accumulation which may or may not progress to secondary infection)
Antibiotics:
Consider if nipple fissure infected or symptoms no better after 12-24 hours of effective milk removal (i.e consider watch/wait or delayed antibiotics initially as cause may be inflammatory rather than infective)
Flucloxacillin 500 mg QDS for 10-14 days (if penicillin allergic: erythromycin 250-500 mg QDS or clarithromycin 500 mg BD for 10-14 days)
Mastitis in non-lactating women:
(Note: Most common organisms: Staphylococcus aureus, enterococci and anaerobic bacteria hence the need for broad-spectrum antibiotics (although worth noting some discrepancy in antibiotic choice as PHE/NICE guidance does not differentiate between lactating and non-lactating women)
Antibiotics to all women:
Co-amoxiclav 500/125mg TDS 10-14 days (if penicillin allergic - a combination of erythromycin (250–500 mg QDS) OR clarithromycin (500 mg BD) + metronidazole (500 mg TDS) for 10–14 days
To return if symptoms fail to settle after 48 hours (the risk of abscess)
Reference(s):