Supportive and lactation management
›Symptom control and breast care
›Analgesia
›Ibuprofen 400 mg PO every 6 to 8 hours as needed
›Acetaminophen 650 mg PO every 6 hours as needed
›Hydration
›Oral fluids
›IV fluids if dehydration or sepsis physiology
›Local measures
›Cold packs for pain and swelling
›Warmth briefly before feeding if improves milk flow
›Milk removal strategy
›Continue breastfeeding if tolerated
›Infant safe with maternal antibiotics in typical regimens
›Improved drainage reduces stasis
›Pumping if infant cannot latch
›Gentle expression
›Avoid overpumping beyond infant demand
›Latch optimization
›Lactation consultant referral
›Address nipple trauma drivers
›Breast manipulation cautions
›Avoid aggressive deep massage
›Avoid excessive “emptying” goals when oversupply suspected
›Avoid traumatic pumping suction settings
Antibiotics for bacterial mastitis
›Indications
›Persistent systemic symptoms beyond 24 hours
›Moderate to severe local findings
›Cellulitis pattern
›No improvement after supportive care window
›First-line oral regimens for MSSA coverage
›Dicloxacillin 500 mg PO 4 times daily
›Duration 10 to 14 days
›Cephalexin 500 mg PO 4 times daily
›Duration 10 to 14 days
›Flucloxacillin 500 mg to 1 g PO 4 times daily
›Duration 10 to 14 days
›MRSA risk or beta-lactam allergy regimens
›Clindamycin 300 mg PO 4 times daily
›Duration 10 to 14 days
›C difficile risk counseling
›Trimethoprim-sulfamethoxazole 160 mg/800 mg PO twice daily
›Duration 10 to 14 days
›Avoid if infant premature or neonatal hyperbilirubinemia risk
›Treatment adjustment
›If no improvement after 48 hours
›Milk culture
›Ultrasound for abscess
›Antibiotic change based on susceptibilities
›Evidence framing
›Early supportive care window before antibiotics for mild cases
›Antibiotics when bacterial infection likely or systemic illness present
›Drainage strategy
›Ultrasound-guided aspiration
›Preferred initial approach when feasible
›Repeat aspiration for recurrence
›Catheter drainage
›Large collections
›Multiloculated collections
›Surgical incision and drainage
›Failure of percutaneous drainage
›Skin necrosis
›Complex loculations not amenable to aspiration
›Antibiotics with abscess
›MRSA-active coverage if risk or local prevalence high
›Tailor to aspirate culture results
›Breastfeeding considerations
›Continued breastfeeding or milk expression from affected breast when tolerated
›Avoid abrupt weaning during acute infection when possible
IV antibiotics and inpatient regimens
›Indications
›Sepsis physiology
›Inability to tolerate oral therapy
›Rapid progression
›Significant comorbidity or immunocompromise
›Empiric IV options
›Vancomycin IV dosing per weight and renal function
›MRSA coverage
›Therapeutic drug monitoring pathway
›Beta-lactam IV option for MSSA based on local protocols
›Transition to oral within 24 to 48 hours if improving
›Transition criteria
›Defervescence
›Downtrending pain and erythema
›Oral intake adequate
›Reliable follow-up