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Antibiotics for mastitis

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  • #1

    Antibiotics for mastitis

    Hello Dr Hale

    Greetings from Australia!

    Could you please tell me your recommendations for oral antibiotic treatment of mastitis & also the length of time they should be continued?

    Thanks for your help in advance.

    Wishing you & your team peace & joy for the festive season.

    Regards, Julieanne Hensby
    IBCLC
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  • #2
    Julieanne:

    First line therapy: Dicloxacillin or flucloxacillin, or other good anti-staphylococcal cephalosporin. Azithromycin in penicillin-allergic patients. If the symptoms are not better in 24-48 hours, then you need treatment for resistant Staph. Avoid erythromycin due to increased risk of pyloric stenosis in infants.

    Second line therapy: If symptoms are not better with above treatment, Clindamycin is my first choice. Order a D-test to be sure the species is not resistant.

    Third line Therapy: Rifampin, Vancomycin (IV).

    Alternate Therapy: Sulfamethoxazole/Trimethoprim. My last choice. It works very slowly. Do not use in young infants less than about 6 weeks of age. Increases risk of kernicterus in hyperbilirubinemic infants.

    Abscesses almost always require draining to resolve.

    Check out the Academy of Breastfeeding Med. Protocol : http://www.bfmed.org/Media/Files/Protocols/protocol_4mastitis.pdf




    Tom Hale Ph.D.

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