Lactational Mastitis Not Settling After Initial Oral Treatment — What to Do Next
Clinical scenario
A breastfeeding woman presents with lactational mastitis: localised pain, erythema, heat, and swelling of the breast. She has no penicillin allergy. First-line oral management has been initiated, but the expected early response has not occurred.
First-line treatment — goal not reached
Standard first-line management includes regular oral paracetamol and NSAIDs for analgesia, hot and cold packs, oral flucloxacillin or dicloxacillin for at least 5 days, and regular complete breast drainage with continued breastfeeding. The expected outcome is breast inflammation settling within 24–48 hours. When this goal is not met, escalation is required.
Next step
When systemic signs of sepsis are present, intravenous antibiotic therapy is indicated. The full criteria, route, and management approach are specified in the structured protocol.
References
- Lactational mastitis is an inflammatory process affecting the lactating breast.
- It affects the breast parenchyma, causing localised pain, tenderness, erythema and engorgement, and may be accompanied by systemic features such as fever, malaise, rigors, nausea and vomiting.
- Hospitalisation for intravenous antibiotics is rarely required but is indicated if there are systemic signs of sepsis.
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