I. Epidemiology
- Incidence: 9-33% of lactating women
- Most common in first few weeks and nearly all cases within first 3 months
III. Etiology
V. Signs
VI. Labs: Milk Culture
- Indications (not routine)
- Severe Mastitis
- Refractory despite optimal antibiotics for at least 48 hours
- Hospital acquired infection
- Technique
- Cleanse nipple
- Hand express small quantity of Breast Milk and discard
- Hand express a sample into a sterile container
VII. Differential Diagnosis
- Inflammatory Breast Cancer
VIII. Management: General Measures
- Continue with frequent Breastfeeding
- Risk of Breast abscess if Breast engorgement occurs
- Safe for infant to continue to feed despite infection (except if mother HIV positive)
- Ensure proper technique (see prevention below)
- Tylenol
- Ensure adequate hydration
- Apply warm packs and local massage
- Alternate feeding positions
-
Antifungals (Monilial Infection)
- Topical Antifungals on Breast
- Oral Nystatin for infant
IX. Management: Antibiotics
- Course: 10 to 14 days
- Coverage: Staphylococcus aureus (or as directed by culture)
- Antibiotics: Nursing Mothers
- Amoxacillin-Clavulanate (Augmentin) 875 mg orally twice daily
- Cephalexin (Keflex) 500 mg orally four times daily
- Dicloxacillin 500 mg orally four times daily
- Clindamycin 300 mg orally four times daily (for MRSA)
- Ciprofloxacin 500 mg orally twice daily (for MRSA)
- Antibiotics: Non-Breast Feeding women
X. Complications
- Breast abscess
- Obtain bacterial culture
- Treat with needle aspiration or Incision and Drainage
XI. Follow-up
- If not better in 48 hours examine Breast for abscess
- Consider Incision and Drainage
- Early antibiotics prevent abscess formation
XII. Prevention
- Optimal Breast Feeding Technique with good latch-on by infant
- Address predisposing factors early
- Sore nipples suggest problems
- Correct latch-on problems
- Address dry nipples with lanolin
- Avoid plastic-backed Breast pads
- Evaluate infant for anatomic problems (e.g. short frenulum, Cleft Palate)
- Cracked nipples colonized with Staphylococcus aureus should be treated
- Oral antibiotics (e.g. Dicloxacillin) are preferred
- Livingstone (1999) J Hum Lact 15:241-6 [PubMed]
- Blocked milk ducts should be unblocked
- Blocked ducts will appear with a bleb overlying a tender, red area adjacent to nipple
- Remove bleb with moist cloth
- Yeast infection should be treated (both infant and mother)
- Infant: See Thrush for management options
- Mother
- Topical agents: Nystatin or Ketoconazole
- Oral agents: Fluconazole 400 mg on day #1, then 200 mg orally daily for 10 days
- Chetwynd (2002) J Hum Lact 18:168-71 [PubMed]
- Sore nipples suggest problems
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| Definition (MSH) | INFLAMMATION of the BREAST, or MAMMARY GLAND. |
| Concepts | Pathologic Function (T046) |
| MSH | D008413 |
| SnomedCT | 155952005, 155955007, 266644004, 198099006, 266641007, 45198002 |
| French | MASTITE, Inflammation du sein, INFLAMMATION DU SEIN, Mammite, Mastite |
| English | BREAST INFLAMMATION, MASTITIS, Breast inflammation, Breast inflammation NOS, mastitis (diagnosis), mastitis, Mastitis [Disease/Finding], Mastitis, breasts inflammation, Breast inflammation NOS (disorder), Mammitis, Mastitis (disorder), breast; inflammation, inflammation; breast, Mastitis, NOS, Mastitis NOS |
| Portuguese | MASTITE, Inflamação da mama, INFLAMACAO DA MAMA, Mamite, Mastite |
| Spanish | MASTITIS, Inflamación mamaria, MAMA, INFLAMACION, inflamación mamaria, SAI, Breast inflammation NOS, inflamación mamaria, SAI (trastorno), Mamitis, mastitis (trastorno), mastitis, Mastitis |
| German | MASTITIS, Brustentzuendung, BRUSTENTZUENDUNG, Mammitis, Mastitis |
| Japanese | 乳腺炎, ﾆï½ï½³ï½¾ï¾�ï½´ï¾�, 乳房炎症, ﾆï½ï½³ï¾Žï¾žï½³ï½´ï¾�ｼｮｳ |
| Swedish | Bröstkörtelinflammation |
| Dutch | mastitis, borstontsteking, mammitis, mamma; ontsteking, ontsteking; mamma, Mastitis |
| Italian | Infiammazione mammaria, Mammite, Mastite |
| Czech | mastitida, Zánět prsu, Mastitida |
| Finnish | Mastiitti |
| Russian | MASTIT, М�СТИТ |
| Croatian | MASTITIS |
| Polish | Zapalenie sutka |
| Hungarian | Emlő gyulladás, mastitis, Mammitis |
| Norwegian | Brystkjertelbetennelse, Brystbetennelse, Mastitt |
