HNY Central Digital Repository - York

Mastitis is a painful inflammatory condition of the breast which may or may not be accompanied by infection.

In lactating women, milk stasis is usually the primary cause.

In non-lactating women – it is usually associated with infection:

• Central/subareolar is usually secondary to damaged ducts.
• Peripheral infection is less common and associated with diabetes, Rheumatoid disease, trauma, corticosteroid treatment but often there is no underlying cause. Often associated with smoking.

Breast abscess is a localized collection of pus – which may or may not be preceded by mastitis.

• Infection not responding to antibiotics or signs of sepsis – Admit
• Treatment failure or recurrence – refer especially if > 50yrs old

• 2WW if there is underlying mass or any other features suggestive of cancer

• Lactating woman – analgesia, warm compress. Continue breast feeding or expression of milk. Prescribe antibiotic as per NICE guidelines.
  • Prescribe an oral antibiotic if the woman has a nipple fissure that is infected, symptoms have not improved (or are worsening) after 12–24 hours despite effective milk removal, and/or breast milk culture is positive.
  • If breast milk culture results are available, treat with an antibiotic that the organism is sensitive to.
  • If breast milk culture results are not available:
  • Treat empirically with flucloxacillin 500 mg four times a day for 10–14 days.
  • If the woman is allergic to penicillin, prescribe either erythromycin 250–500 mg four times a day or clarithromycin 500 mg twice a day for 10–14 days.
     
• Non-lactating woman – analgesia, warm compress. Manage any underlying condition e.g., nipple fissure due to eczema, candida skin infection. Prescribe antibiotics as per NICE guidelines:
  • Prescribe an oral antibiotic for all women with non-lactational mastitis:
  • Prescribe co-amoxiclav 500/125 mg three times a day for 10–14 days, note coamoxiclav is associated with increased risk of Clostridium difficile infection.
  • If the woman is allergic to penicillin, prescribe a combination of erythromycin (250–500 mg four times a day) or clarithromycin (500 mg twice a day) plus metronidazole (500 mg three times a day) for 10–14 days.

None

• Urgent referral / acute admission if not responding or patient unwell.
• 2WW if suspicious signs

Patient information leaflets/ PDAs

Mastitis - NHS (www.nhs.uk)

Mastitis and Breast Abscess | Breast-feeding Your Baby | Patient

References

Acute Breast Sepsis (kernowccg.nhs.uk) updated Dec 2019

CKS mastitis-breast-abscess updated Jan 2021

Responsible Consultant: Miss Jenny Piper

Responsible GP: Dr Ruth Guest

Responsible Pharmacist: Jamal Hussain