see also:

• gynaecology
• The Womens Hospital Melbourne patient fact sheet - mastitis

• mastitis is a common complication of lactation in the post partum period and is usually caused by Staphylococcus aureus.
• see the above fact sheet for its prevention and early Mx.

• maintain adequate fluid intake
• continue breast feeding:
  • the milk is safe for the baby.
  • it is important to continue to breastfeed or express from the affected breast.
  • if the breast is not well drained, symptoms may worsen and the milk supply may drop in this breast.
• look for and exclude presence of breast abscess which may require surgical drainage
  • consider diagnostic ultrasound if suspect abscess formation
• mild cases can be Rx with oral flucloxacillin 500mg qid
• more severe cases or non-responsive cases often require admission under the obstetrics unit and iv flucloxacillin
• monitor hepatic function if flucloxacillin treatment continues for > 2 weeks, especially if there are other risk factors.
• if allergic to penicillin consider oral cephalexin 500mg qid or cephazolin 1g iv tds
• if history of immediate penicillins allergy, consider clindamycin 450mg qid o for 5 days or 450mg tds iv, or vancomycin 1g bd iv if pathogen sensitivity is confirmed.