Pathophysiology: Mastitis is a result of ineffective removal of milk from the breast. This results in stasis in an area of breast tissue. This sets up an inflamma-tory process leading to pain, erythema and pyrexia. If it is not resolved the area becomes infected. Infec-tion is more likely to occur if the mother has cracked nipples as this provides a portal of entry for infectious organisms. (1, 2, 3)

Presentation: It presents with fever, malaise, flu-like symptoms, myalgia, mild breast tenderness or severe breast pain.

Examination: may reveal a wedge shaped area of the breast which is pink, hot, swollen and tender.

Treatment:• Increase frequency of feeds from affected breast.

The mother may need to use a breast pump to express milk from this breast if the baby will not latch on.

• Analgesia such as paracetamol or non-steroidal anti-inflammatories.

• Rest – this allows the baby to feed more frequent-ly and stimulates the release of prolactin.

• Antibiotics – most women with mastitis need antibiotics. Antibiotic options include:

o Flucloxacillin 500mgs 6 hourly (first line)o Erythromycin 250-500mgs 6 hourly (penicillin

sensitivity)o Co-amoxiclav 625mgs 8 hourly

o Cephalexin 500mgs 8 hourlyPrescribe antibiotics for 10-14 days to prevent recurrence.

Culture of breastmilk may be useful in persistent or recurrent infections.(6) This should be discussed with the local microbiologist before sending a sample.

Blocked ductsIt is not easy to distinguish mastitis from a blocked duct. A blocked duct presents as a painful, swollen firm mass in the breast. It usually resolves within 24-48hrs if managed correctly. Management involves, res t, increased frequency of feeding from the affected breast, and heat applica-tion. If it has not resolved within 48 hrs therapeutic ultrasound may be beneficial. The author has no personal experience of acquiring this treatment for patients. It is not a well known use of ultrasound. The dose is 2 watts/cm2, continuous for five minutes to the affected area, once daily for up to two doses.(4)

Breast abscessBreast abscess occurs in 5-10% of patients with masti-tis and is often associated with delayed or inadequate treatment of mastitis.It presents as a painful, firm lump which will not go away. It is usually hot, red and the mother will feel unwell. All suspected breast abscesses need special-ist referral. It is important to advise the mother to continue breastfeeding especially on the affected side. Breast lumps are usually treated by repeated needle aspiration under radiological control. Surgical incision and drainage is not commonly required in recent times. (5)

© Health Service Executive 2008

FACTSHEET

04Mastitis

Breastfeeding Information for GPs and Pharmacists

Mastitis

This is an inflammatory condition of the breast that is frequently accompanied by infection. It is most common in the first 12 weeks postpartum and occurs in up to 33% of breastfeeding women.

Breastfeeding Information for GPs and Pharmacists

© Health Service Executive 2008Mastitis

It is not necessary or advisable to discontinue breastfeeding while undergoing treatment for blocked ducts, mastitis or breast abscess. If a mother decides to stop breastfeeding it is important to encourage her to do this gradually to avoid any of the problems outlined above.

References1. Hale TW, Berens P. Clinical therapy in breastfeeding patients. Amarillo, TX: Pharmasoft Publishing, 2002.2. Riordan J, Auerbach KG. Breastfeeding and human lactation (Second edition). Boston: Jones and Bartlett,

1999.3. Department of Child and Adolescent Health and Development: World Health Organization. Mastitis:

causes and management. Geneva: WHO, 2000.4. Handout blocked ducts and mastitis. Revised May 2008. Dr. Jack Newman, MD, FRPC. Edith Kernerman.

IBCLC5. Breast Abscess in Lactating Women. Dieter et al. Radiology 2004; 232:904-9096. Clinical thera;y in breastfeeding patients. Thomas Hale and Pamela Berens