The clinic, midwife, or office of the physician will most likely receive a call from the mother at home. The condition rarely occurs in the hospital. She will likely report general malaise, fatigue, headache, chills, an increased heart rate, and flu-like symptoms. Usually, only one breast is involved. An area of the affected breast becomes swollen, red, hard, and painful. A red streak may be evident. Often, the location of the infection is in the upper, outer quadrant, which is the location of most of the glandular tissue.
Lumps in the breasts may result from plugged milk ducts. Plugged ducts can contribute to mastitis. If the mother describes pain in both breasts, then the condition might be engorgement of the breasts, as opposed to mastitis, which almost always occurs unilaterally.
A definitive diagnosis of the offending pathogen involves obtaining a sample of breast milk from the infected breast. A culture is done to identify the pathogen. In practice, however, laboratory studies are done infrequently because antibiotic therapy is initiated before results are returned, and insurance companies may not cover the cost of the tests.
A penicillinase-resistant penicillin or a cephalosporin, for six to 10 days, can both be used to treat mastitis. Low doses of erythromycin or trimethoprin-sulfamethoxazole over an extended period of time have been used to treat chronic mastitis. Breastfeeding should be continued, because the rate of abscess formation in the infected breast increases sharply among women who stop breastfeeding during a bout of mastitis. Some symptoms of mastitis respond solely to frequent breastfeeding and pumping, without requiring antibiotic therapy. Most practitioners allow women to take acetaminophen while nursing, to relieve both fever and pain. Since almost all drugs the mother takes appear in her breast milk, any medication taken by breastfeeding women must also be safe for the baby. Warm, moist compresses applied to the affected breast can be soothing. Increasing fluid intake and bed rest are also recommended.
Nadine M. Jacobson, The Gale Group Inc., Gale, Detroit,