Neonatal mastitis pathway separate from lactational mastitis
Lower threshold for systemic evaluation
Ultrasound for abscess evaluation
Medication safety through breastmilk
TMP-SMX avoidance in premature infants or hyperbilirubinemia risk
Monitor infant for diarrhea or thrush with maternal antibiotics
Epidemiology
Epidemiologic patterns
Most common in early postpartum months
Associated with milk stasis and breastfeeding disruption
Abscess as complication subset of mastitis cases
Microbiology patterns
Staphylococcus aureus common pathogen
MRSA prevalence varies by region and risk profile
Pathophysiology
Mastitis spectrum concept
Ductal inflammation and narrowing
Milk stasis and pressure
Secondary bacterial overgrowth in some cases
Progression to phlegmon and abscess if untreated or severe
Abscess formation
Localized pus collection
Often follows persistent inflammation and infection
Requires drainage for definitive source control
Therapeutic Considerations
Rationale for continuing breastfeeding
Promotes physiologic drainage
Reduces milk stasis
Maintains lactation goals
Rationale for supportive care window
Some cases primarily inflammatory
Antibiotic stewardship
Rationale for 10 to 14 day antibiotic courses when used
Reduce relapse risk
Address deeper tissue involvement possibility
Rationale for ultrasound and drainage
Antibiotics alone inadequate for established abscess
Image-guided drainage preserves breastfeeding and reduces morbidity
copy discharge instructions
Home care
Continue breastfeeding or gentle pumping as tolerated
Ibuprofen and acetaminophen as directed
Cold packs for swelling
Rest and hydration
Avoid aggressive breast massage
Antibiotics
Complete full course if prescribed
Expected improvement within 24 to 48 hours
Diarrhea or rash monitoring
Return to ED now
Fainting
Confusion
Severe weakness
Shortness of breath
Persistent vomiting
Rapidly spreading redness
New purple or black skin changes
Severe pain out of proportion
Urgent reassessment within 24 hours
Fever persisting beyond 24 hours after starting antibiotics
No improvement at 48 hours
New lump or fluctuant area
Pus drainage from skin
Recurrent mastitis in same location
Follow-up
Primary care or obstetric provider follow-up in 24 to 48 hours if not clearly improving
Lactation consultant follow-up for latch and milk supply optimization
Clinical guidelines and evidence sources
Key sources
Academy of Breastfeeding Medicine Clinical Protocol #36
Mastitis spectrum framework
Antibiotic stewardship emphasis
Supportive care measures
ACOG Committee Opinion on breastfeeding challenges
Preferred antibiotics
Continued breastfeeding recommendations
NICE CKS mastitis and breast abscess guidance
Antibiotic duration 10 to 14 days
Escalation and imaging pathways
StatPearls acute mastitis review
Supportive care window
Ultrasound and culture after 48-hour nonresponse
Cleveland Clinic Journal of Medicine review on lactational mastitis
Second-line MRSA-active regimens
Duration 10 to 14 days
Ultrasound-guided abscess management review literature
High success rates for image-guided drainage
Reduced scarring and preserved breastfeeding
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