Mastitis

• Abrupt change in feeding frequency.
• Cracked nipples.
• An unresolved, plugged duct.
• Constriction around breast tissue (e.g. underwire bra, baby carrier, or other items that restrict or puts pressure on milk ducts).
• Untreated engorgement.

• Administer antibiotics.
• Consider use of analgesic, both for pain and reduction of inflammation.
• Assess the baby’s latch and positioning.
• Encourage her to rest, preferably when the baby sleeps.
• Increase fluids for the mother.
• Increase feedings at the breast or use a hospital-grade electric breast pump, hand expression or both between feedings, if necessary.
• When fever and a lump are present, assess for a possible abscess.
• Consider a culture of the breastmilk if:
  • Not responsive to antibiotics (as well as imaging) vs. empiric change to MRSA coverage
  • Not directly breastfeeding (most organisms from infant’s oropharynx/ nasal passage)
  • Mother recently hospitalized (possible hospital acquired infection)
  • Infant ill or in NICU
  • Mother with multiple allergies and you are choosing an unusual antibiotic therapy
  • Recurring infection
• Be familiar with community’s resistance patterns to antibiotics
• If the mother is clinically ill, encourage her to seek medical care.
• Continue breastfeeding or pumping, weaning during mastitis may increase risk of breast abscess.

Predisposing Factors

• Mother discontinued taking the antibiotics before full treatment ended.
• The course of antibiotic treatment was too short.
• Inappropriate antibiotics were prescribed, or the bacteria was resistant to the antibiotic.
• Predisposing factors such as poor latch, positioning, nipple trauma or oversupply were not resolved.
• Underlying breast disease.

Management Recommendations

• Reevaluate the baby’s latch and position if nipple trauma is present.
• Encourage bed rest.
• Do a midstream culture of the breastmilk.
• Consider prescribing a different antibiotic.
• If the mastitis lacks typical systemic characteristics such as pain or fever, consider investigating for Paget’s disease or inflammatory breast cancer.
• If oversupply symptoms are present, treat for oversupply.

Clinical Guidelines

• Mitchell, K.B., Johnson, H.M., Eglash, A., & Academy of Breastfeeding Medicine (2019). ABM Clinical Protocol #30: Breast Masses, Breast Complaints, and Diagnostic Breast Imaging in the Lactating Woman. Breastfeeding Medicine, 14(4), 208-214. 
• Mitchell, K., Johnson, H., Rodriguez, J.,Eglash, A. (2022). ABM Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeeding Medicine, 17(5), 360-376.

References 

1. Campbell, S. H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core curriculum for interdisciplinary lactation care. Jones & Bartlett Learning. 
2. Lawrence, R. A., & Lawrence, R. M. (2016). Breastfeeding: A guide for the medical profession (8th ed.). Elsevier. 
3. Witt, A. M., Bolman, M., Kredit, S., & Vanic, A. (2016). Therapeutic Breast Massage in Lactation for the Management of Engorgement, Plugged Ducts, and Mastitis. Journal of Human Lactation, 32(1), 123–131.