Inpatient Management of Mastitis

Introduction to Treatment

• The American Academy of Pediatrics recommends continued breastfeeding or milk expression, appropriate antibiotic therapy targeting Staphylococcus aureus, and drainage of any abscesses that may have formed for inpatient treatment of mastitis 1

Continued Breastfeeding/Milk Expression

• Regular feeding or expression of milk is an essential component of treatment for mastitis and should be encouraged to continue even during hospitalization 1
• Breastfeeding can continue on the affected side even if an abscess has formed, provided the infant's mouth does not contact purulent drainage from the breast 1

Supportive Care

• Pain management with appropriate analgesics is essential, as pain can exacerbate symptoms, according to the National Comprehensive Cancer Network 2

Management of Lactational Mastitis

Initial Management Approach

• Mothers with mastitis should be encouraged to continue breastfeeding, as regular feeding or expression of milk is an essential part of treatment, according to the American Academy of Pediatrics 3

Management of Complications

• Approximately 10% of mastitis cases progress to breast abscesses, which require drainage, and breastfeeding can continue on the affected side as long as the infant's mouth does not contact purulent drainage from the breast, as recommended by the American Academy of Pediatrics 3
• Discontinuing breastfeeding during mastitis treatment can worsen the condition, and delaying treatment of non-responsive cases may lead to abscess formation, as noted by the American Academy of Pediatrics 3

Treatment of Puerperal Mastitis

Hospital Environment Support

• The American Society of Anesthesiologists recommends providing a breast pump if prolonged separation occurs to reduce risk of worsening mastitis, ensuring access to trained breastfeeding support staff, and scheduling procedures to allow breastfeeding or milk expression as close to surgery as possible if hospitalization is required 4

Treatment of Postpartum Mastitis with Fever and Chills

Initial Assessment and Hospitalization

• The presence of fever and chills in a postpartum patient with mastitis indicates systemic involvement and warrants close monitoring, with hospitalization considered for worsening symptoms or concern for sepsis, as suggested by Intensive Care Medicine 5

Management of Systemic Involvement

• The American Academy of Pediatrics supports continued breastfeeding and conservative management, followed by antibiotics if necessary, although the evidence quality is limited, with one study suggesting faster symptom clearance with antibiotics, and clinical practice and expert consensus supporting this approach 5