1. Breastfeeding
Information for GPs and Pharmacists
FACTSHEET
Mastitis 04
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.
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. Blocked ducts
It is not easy to distinguish mastitis from a blocked
Examination: may reveal a wedge shaped area of duct. A blocked duct presents as a painful, swollen
the breast which is pink, hot, swollen and tender. firm mass in the breast. It usually resolves within 24-
48hrs if managed correctly.
Treatment: Management involves, res t, increased frequency of
• Increase frequency of feeds from affected breast. feeding from the affected breast, and heat applica-
The mother may need to use a breast pump to tion. If it has not resolved within 48 hrs therapeutic
express milk from this breast if the baby will not ultrasound may be beneficial. The author has no
latch on. personal experience of acquiring this treatment for
• Analgesia such as paracetamol or non-steroidal patients. It is not a well known use of ultrasound.
anti-inflammatories. The dose is 2 watts/cm2, continuous for five minutes
• Rest – this allows the baby to feed more frequent- to the affected area, once daily for up to two doses.(4)
ly and stimulates the release of prolactin.
• Antibiotics – most women with mastitis need Breast abscess
antibiotics. Antibiotic options include: Breast abscess occurs in 5-10% of patients with masti-
o Flucloxacillin 500mgs 6 hourly (first line) tis and is often associated with delayed or inadequate
o Erythromycin 250-500mgs 6 hourly (penicillin treatment of mastitis.
sensitivity) It presents as a painful, firm lump which will not go
o Cephalexin 500mgs 8 hourly (second line) away. It is usually hot, red and the mother will feel
o Co-amoxiclav 625mgs 8 hourly (third line) unwell. All suspected breast abscesses need special-
Prescribe antibiotics for 10-14 days to prevent ist referral. It is important to advise the mother to
recurrence. continue breastfeeding especially on the affected
side. Breast lumps are usually treated by repeated
Culture of breastmilk may be useful in persistent or needle aspiration under radiological control. Surgical
recurrent infections.(6) This should be discussed with incision and drainage is not commonly required in
the local microbiologist before sending a sample. recent times. (5)
Mastitis © Health Service Executive 2008

2. Breastfeeding
Information for GPs and Pharmacists
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.
References
1. 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.
IBCLC
5. Breast Abscess in Lactating Women. Dieter et al. Radiology 2004; 232:904-909
6. Clinical thera;y in breastfeeding patients. Thomas Hale and Pamela Berens
Mastitis © Health Service Executive 2008