A 26-year-old primiparous woman who is exclusively breastfeeding develops a painful, erythematous, wedge-shaped area in the right breast on day 10 postpartum, with fever of 38.7 degrees C and myalgia. There is no fluctuance. The most appropriate management is:
- A Continue breastfeeding on the affected side and start flucloxacillin ✓
- B Stop breastfeeding on the affected side and suppress lactation with bromocriptine
- C Immediate incision and drainage under anaesthesia
- D Warm compresses alone and review in 48 hours without antibiotics
Correct answer: A. Continue breastfeeding on the affected side and start flucloxacillin
Explanation
Lactational mastitis is caused by Staphylococcus aureus entering through nipple cracks. Treatment is continued emptying of the breast, preferably by feeding or expression, plus an antistaphylococcal penicillin such as flucloxacillin. Stopping feeding worsens engorgement and delays resolution, and bromocriptine is obsolete for suppression. Incision and drainage is reserved for a formed breast abscess, indicated by a fluctuant mass or failure of 48 hours of antibiotics; this patient has no fluctuance.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.