Mastitis

By Julie S. Moldenhauer, MD, Associate Professor of Clinical Obstetrics and Gynecology in Surgery, The Garbose Family Special Delivery Unit;Attending Physician, The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia;The University of Pennsylvania Perelman School of Medicine

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Postpartum Care and Associated Disorders
Postpartum Care
Mastitis
Puerperal Endometritis
Postpartum Pyelonephritis
Postpartum Depression

Mastitis is painful inflammation of the breast, usually accompanied by infection.

Fever later in the puerperium 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.

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 start of breastfeeding.

Diagnosis of mastitis is clinical.

Treatment

Antistaphylococcal antibiotics

Treatment of mastitis includes encouragement of fluid intake and antibiotics aimed at Staphylococcus aureus, the most common causative pathogen. Examples are

Dicloxacillin 500 mg po q 6 h for 7 to 10 days
For women allergic to penicillin, cephalexin 500 mg po qid or clindamycin 300 mg po tid for 10 to 14 days

Erythromycin 250 mg po q 6 h is used less frequently.

If women do not improve and do not have an abscess, vancomycin 1 g IV q 12 h or cefotetan 1 to 2 g IV q 12 h to cover resistant organisms should be considered. Breastfeeding should be continued during treatment because treatment includes emptying the affected breast.

Breast abscesses are treated mainly with incision and drainage. 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.

Last full review/revision January 2016 by Julie S. Moldenhauer, MD