Lactational mastitis
Inflammation of the breast in a breastfeeding woman with possible bacterial infection. Per Academy of Breastfeeding Medicine Clinical Protocol #36 (2022), the inflammatory continuum of milk stasis. Symptoms: localized breast erythema and tenderness, fever ≥38.5°C, malaise. Most common pathogen: Staphylococcus aureus (MSSA, less often MRSA). Treatment: continue breastfeeding (drainage priority), 10–14 days of antibiotics (cephalexin or flucloxacillin first-line), analgesics, cold compresses after feeds. Without proper drainage, antibiotics fail.
Also known as: Postpartum mastitis, Breastfeeding mastitis
Drugs used for this condition
- ACefalexinFirst line · First-generation cephalosporinLactational mastitis due to MSSA. Per ABM Protocol #36 2022 and SEGO 2023, first-line 500 mg 4 times daily for 10–14 days. If no improvement by 48 h – assess breast drainage, consider MRSA (switch to clindamycin) or abscess (ultrasound + aspiration). Continue breastfeeding on the affected side.
- AFlucloxacillinFirst line · Beta-lactamase-resistant penicillinMSSA lactational mastitis. Per NICE CKS 2023 and UK Drug Tariff, first-line in UK and Spain at 500 mg 4 times daily for 10–14 days. Alternative – cephalexin (equivalent efficacy). Penicillin-intolerant – clindamycin.
- BClindamycinSecond line · Lincosamide antibioticLactational mastitis with penicillin intolerance or suspected MRSA. Per ABM Protocol #36 2022 and SEGO 2023, second-line 300–450 mg 4 times daily for 10–14 days. Particularly indicated for community-acquired MRSA (CA-MRSA) – usually clindamycin-susceptible, unlike hospital MRSA.
- BMupirocinAdd-on therapy · Topical antibioticInfected nipple cracks as entry route for mastitis. Per ABM Protocol #36 2022, thin layer after feeds 2–3 times daily for 5–7 days. Before the next feed – do not wipe off (minimal residue is safe for the infant).
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit