- If the mother has symptoms consistent with mastitis for more than 24 hours, she should start antibiotics. If the mother has consistent symptoms for less than 24 hours, I will prescribe an antibiotic, but suggest the mother wait before starting to take it. If, over the next 8-12 hours, her symptoms are worsening (more pain, more spreading of the redness, enlargement of the hardened area), then the mother should start the antibiotics. If, over the next 24 hours, the mother has not worsened, but not improved, she should start the antibiotics. However, if symptoms are starting to decrease, there is no need to start the antibiotics. The symptoms usually will continue to resolve and will have disappeared over the next 2 to 5 days. Fever will usually be gone within 24 hours, the pain within 24 to 48 hours, the breast hardness within the next few days. The redness may remain for a week or longer. Once improvement begins, on or off antibiotics, it should continue. If the course of your mastitis does not follow this pattern, contact the clinic.
- Continue breastfeeding, unless it is just too painful to do so. If you cannot, at least express your milk as best you can in the meantime. Restart breastfeeding as soon as you are up to it, the sooner the better. Continuing breastfeeding helps mastitis to resolve more quickly. There is no danger for the baby.
- Heat (hot water bottle or heating pad), applied to the affected area helps healing.
- Rest helps fight off infection.
- Fever helps fight off infection. Treat fever if it makes you feel bad, not just because it is there.
- Medication (acetaminophen, ibuprofen) for pain can be very good. You will feel better and the amount that gets to the baby is insignificant.
Note: Amoxycillin, plain penicillin, and many other antibiotics often prescribed for mastitis are usually useless for mastitis. If you need an antibiotic, you need one which is effective against Staphylococcus aureus. Effective for this bacterium are: cephalexin, cloxacillin, flucloxacillin, amoxycillin-clavulinic acid, clindamycin and ciprofloxacin. The last two are effective for mothers allergic to penicillin. You can and should continue breastfeeding with all these medications.
Abscess: Abscess occasionally complicates mastitis. You do not have to stop breastfeeding, not even on the affected side. Usually the abscess needs to be drained surgically, but you should continue breastfeeding.
Revised January 2000
Written by Jack Newman, MD, FRCPC
Used with permission.