Puerperal mastitis

Mastitis is an inflammation of the breast that, if mishandled, can end up becoming infected. When there is infection, the most frequently implicated germ is Staphylococcus aureus ^{(Cullinane 2022, Paricio 2017, Amir 2016, Espinola 2016, Baeza 2015, Amir 2014, Spencer 2008)}.

Coagulase negative staphylococci (CoNS) such as S. epidermidis are not associated with mastitis ^{(Culinane 2022)}. There is also no evidence that bacterial biofilms are a cause of blocked ducts and mastitis. ^{(Douglas 2022)}. Studies are needed to determine the aetiological role of Candida albicans, which appears to be a minority. ^{(Amir 2014, Hanna 2011, Carmichael 2002, Brent 2001)}

Damaged nipple, infrequent feedings, scheduled frequency or duration of feedings, missed feedings and poor latch are risk factors for mastitis. ^{(Wilson 2020, Amir 2014)}

Effective treatment requires resting of the mother, a frequent emptying of the breast, use of anti-inflammatory drugs and in case of no amelioration, it should be necessary a course of antibiotics that must be effectively active against Staphylococcus aureus. ^{(Paricio 2017, Espinola 2016, Amir 2014, Cabou 2011, Spencer 2008)}. High-quality double-blind RCTs are needed to determine the use of antibiotics in mastitis. ^{(Jahanfar 2013)}

The nursing infant may be latched on to the inflamed breast without bad consequences for the child ^{(Amir 2014, Lawrence 2013, WHO 2000)}. Emptying of the breast is important for treatment, with the baby being the most effective extractor. Better results are obtained with a continued lactation during the treatment with antibiotics. Incidentally, the baby may refuse sucking the breast because a salted flavor of the milk, in which case, it should be manually or mechanically pumped.

Medication used for the treatment of mastitis, such as antibiotics and anti-inflammatory drugs, is compatible with breastfeeding.

Breast milk culture is only indicated if ^{(Paricio 2017, Espínola 2016, Amir 2014)}: 

• no response to antibiotic therapy within 48 hours
• return or recurrence of mastitis
• nosocomial mastitis (hospital-acquired)
• patient allergic to beta-lactam antibiotics
• region with excessive frequency of methicillin-resistant staphylococci
• serious or unusual case of entry

As of the last review, there is no valid scientific evidence that the use of probiotics is effective in treating mastitis or breast pain in women ^{(WHO 2022, Crepinsek 2020, Barker 2020, Paricio 2017, Espínola 2016, Amir 2016, Baeza 2015, Amir 2014)}. Its indiscriminate use can delay other treatments and be financially burdensome ^{(WHO 2022, Amir 2016)}.Evidence that orally administered can get into the milk is lacking. ^{(Elias 2011)}

The use of presumably preventive probiotics during pregnancy was associated with an increased risk of mastitis and other complications of breastfeeding during the first month of breastfeeding. ^{(Karlsson 2019)}

See below the information of these related products:

• Cefadroxil ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
• Cephalexin ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
• Cloxacillin; Cloxacillin Sodium ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
• Ibuprofen ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
• Paracetamol ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
• Probiotics (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)