What is the role of antibiotic therapy in the treatment of mastitis?

Updated: Jul 27, 2020
  • Author: Andrew C Miller, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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For detailed therapy, see Mastitis Empiric Therapy and Mastitis Organism-Specific Therapy.

In general, mastitis is treated with antibiotic therapy for 10-14 days, warm or cold compresses, and continued breast emptying via breastfeeding or breast pumping every 2 hours or when engorged.

Antibiotic therapy with continued breast emptying has been shown to be superior to breast emptying alone for resolving symptoms, decreasing recurrence rate, and decreasing the risk of abscess development. [1, 9] The addition of appropriate antibiotic administration may relieve symptoms in 2.1 days, as compared with 4.2 days for supportive care or 6.7 days if no action is taken. [9] In breastfeeding mothers, use beta-lactamase stable penicillin. Other choices include dicloxacillin 500 mg orally 4 times daily or cephalexin 500 mg orally 4 times daily for 10-14 days. Instruct patients who are lactating that continued breastfeeding from the affected breast is not harmful to the baby. For nonpuerperal mastitis, use clindamycin 600 mg intravenously every 8 hours or 300 mg orally every 6 hours, or amoxicillin/clavulanate 500 mg orally 3 times daily. [73] If a breast abscess is suspected in a nursing mother, the affected breast should not be used to nurse the baby owing to the risk of passing infection to the baby. [4]

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