A breastfeeding mother presents on day 12 postpartum with a unilateral, erythematous, painful, wedge-shaped area of breast induration and fever of 38.7 degrees Celsius. There is no fluctuant mass. Milk cultures are not routinely sent. What is the most appropriate management?
- A Stop breastfeeding from the affected breast and express and discard the milk until healed
- B Continue frequent feeding or expression from the affected breast together with flucloxacillin ✓
- C Start cabergoline to suppress lactation and review in one week
- D Immediate incision and drainage under general anesthesia
Correct answer: B. Continue frequent feeding or expression from the affected breast together with flucloxacillin
Explanation
Puerperal mastitis is caused by Staphylococcus aureus in the great majority of cases, entering through nipple cracks. Treatment is an antistaphylococcal antibiotic such as flucloxacillin plus continued emptying of the affected breast, since stopping drainage worsens engorgement and abscess formation. Breastfeeding from the affected side is safe for the infant. Suppression of lactation is not indicated. Incision and drainage is reserved for a formed abscess, suggested by a fluctuant mass or failure to improve after 48 hours of antibiotics.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.