Bonnie
The history mentions 4 bouts of mastitis but does not say what treatments
were done. I would expect that abx would be needed, I am guessing previous
bouts may not have been effectively treated, or that mom has some risk
factor(s) that have not been identified and modified yet. Not sure what shot
was given but mom may still need p.o. meds for 10 - 14 days when infectious
mastitis (vs inflammatory mastitis) is suspected. First line usually used is
dicloxacillin or cloxacillin. Affected breast should be kept drained, I
would not worry about oversupply at this time. I would also recommend not
neglecting the other breast either, keep both breasts drained. I would
recommend an anti-inflammatory med if mom can take, like ibuprofen, to
reduce inflammation. Once the acute infection is resolved, then you can
explore with mom why she keeps getting mastitis.
I am giving a talk and have done alot of reading. Here are some notes:
Some authors distinguish infectious vs inflammatory.
Risk factors: inefficient removal of milk (milk stasis), blocked duct,
increased levels of stress, fatigue, tight bra, full-time employment, latch
difficulties (portal of entry), nipple pain during a feed, engorgement,
hurried feeds, nipple shield use, overabundant milk supply, lactating for
multiples, anemia, previous history of mastitis, breast yeast infection,
diabetes, and possibly vigorous exercise leading to breast
injury/inflammation.
Bacterial culture (and sensitivity) can be of value; if normal skin flora
the outcome is often good; consider mgmt with frequent breast emptying and
rest. Cell counts and bacterial colony counts may be useful. Treatment -
Continue bf or expressing milk frequently. First line drug of choice is
dicloxacillin or cloxacillin p.o. 250 - 500 mg qid x 10 - 14 days.
Cephalexin or augmentin if sensitivities available. If penicillin allergy,
cephalexin or clindamycin. If cephalosporin hypersensitivity, then
erythromycin if organism is sensitive. Severe infection may require IV
nafcillin, cefazolin, clindamycin. If resistant, then vancomycin IV (see
Hale, 1999).
Breast abscess may occur (5 - 10 % of mastitis cases) - requires I & D
Prevention - most common protective factor in one study was feeding more
frequently than normal (Fetherston, 1998). Rooming-in to colonize the baby
with "friendly" bacteria. No bra first week postpartum (Hale, 1999).
Note: Mastitis is not known to cause cancer, but cancer can present as
mastitis. Cancer can occur at any age, even during pg and lactation.
Incidence is 2 - 3 per 1000 in pg and lactation. Continue breast self-exam
during lactation. Breasts do feel lumpy during lactation. Evaluate lumps
that do not resolve with standard treatment. Be alert to masses that recur
in same area of breast. These need to be evaluated. Warning signs for breast
cancer: skin color changes on breast esp w/o fever, skin texture changes,
peau d'orange (orange peel skin), puckering, indurations, masses (esp fixed,
irregular), copious spontaneous clear or bloody discharge usually
unilateral, mastitis occuring repeatedly in same place (Wilson-Clay &
Hoover, 1999).
Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA
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