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 of mastitis includes encouragement of fluid intake and antibiotics aimed at Staphylococcus aureus, the most common causative pathogen. Examples are
Erythromycin 250 mg orally every 6 hours is used less frequently.
If women do not improve and do not have an abscess, vancomycin 1 g IV every 12 hours or cefotetan 1 to 2 g IV every 12 hours 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.