Mastitis (Lactational)

Female 6 weeks postpartum presents with focal, unilateral breast tenderness. Reports fever, malaise, nipple soreness, and chronic breast engorgement. Denies shooting pains typically associated with yeast infection. Febrile with peri-areolar skin cracking, erythema, warmth, induration, and pain with palpation on exam.

• Evaluate infant for prominent frenulum, cleft palate, thrush

• Treatment

  • Encourage cold compresses and naproxen 500 mg BID for pain

  • Apply topical mupirocin (Bactroban) 2% ointment to affected area

  • Start amoxicillin-clavulanate (Augmentin) 875 mg BID x 10 days

  • Patient failed amoxicillin-clavulanate (Augmentin):

    • Consider breast milk culture to guide therapy

    • Sepsis and/or MRSA mastitis: Admit to hospital and start vancomycin 5 mg/kg/dose q12h

• Refer for lactation counseling

• Counseling

  • Pt encouraged to continue feeding with both breasts during treatment

  • Pt advised to perform frequent, complete emptying of the breast to prevent abscess formation

Notes

• Bilateral erythema decreases likelihood of infectious etiology

• Poor breast drainage increases risk for infection and abscess formation

• Obtain breast milk culture for

  • Failed response to initial treatment

  • Hospital acquired mastitis

  • Severe infections (e.g sepsis)

• Yeast infection treatment

  • Mother: Fluconazole 400 mg on day 1 followed by 200 mg daily for 10+ days

  • Infant: Fluconazole 20 mg/kg on day 1 followed by 5 mg/kg for 10+ days