Infections in Pregnancy: Mastitis

What Do I Have?

Mastitis is a breast infection. Most cases occur in breast-feeding women within the first few weeks after delivery. Occasionally, this infection arises several months after the baby is born.

Mastitis develops when bacteria (usually staphylococci or streptococci ) from the baby's mouth gain entry into the breast by way of the mother's nipple. This causes an infection and inflammation in and around the milk-producing glands. Typically, a woman with mastitis develops a fever and notices pain and redness in one area of the breast. She is likely to develop flu-like body aches and fatigue as well.

What Are the Consequences of Mastitis?

If not recognized or treated, simple mastitis may progress to the formation of an abscess (pus) collection. An abscess is suspected when a lump is present beneath the area of redness on the skin. Because pain and fever prompt most women to contact their doctors early in the course of mastitis, abscess formation is rare. However, when an abscess does develop, it is important to identify because treatment is different than that for simple mastitis.

How Is Mastitis Diagnosed?

Diagnosing mastitis is a straightforward procedure. Reporting the symptoms to your doctor should be enough for him or her to identify the problem and prescribe treatment. In fact, laboratory tests are seldom needed. However, if you delay reporting symptoms to your doctor, a confirmatory physical examination is essential.

What Are the Usual Treatments for Mastitis?

Mastitis typically responds to antibiotic treatment within 24 hours. The drug of choice, dicloxacillin (Dycill), is taken orally, 500 mg every six hours for seven to 10 days. In women who are allergic to penicillin, alternatives include erythromycin (Ery-Tab) 500 mg every six hours or clindamycin (Cleocin) 300 mg every six hours. (Remember, however, that drug doses vary. Your doctor will determine the correct dosage for you.) Also, removing milk from your breast through continued breast-feeding or pumping helps the infection clear up quickly.

If your mastitis does not improve within 48 to 72 hours, you may have an abscess. In these cases, treatment is more aggressive. The abscess has to be lanced (by incision) and drained. This may require a trip to the emergency or operating room. You also need antibiotics. Depending on the severity of the infection, you may be given the antibiotics intravenously rather than orally.

After the abscess is lanced, a sample is sent to the laboratory to identify the bacteria that caused the infection. Though cancer is unusual in young women with postpartum mastitis, a sample of your breast tissue may also be examined to make sure that cancer is not present.

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