maternal immune defenses, and missed feedings. Most often, mastitis is caused by Staphylococcus aureus. Other common organisms are group A or group B streptococci, E coli, and Haemophilus species.
Many women are confused about how to tell if the painful area on the breast is mastitis, a plugged duct, an abscess or engorgement. Equally confusing is how to manage each potential problem. Stop nursing? Pump? Are the antibiotics harmful to the baby?
Below is a table of symptom comparisons which serve as a general guide. The most important recommendation is to have your health care provider evaluate the breast.
Comparison of Findings of Engorgement, Plugged Duct, and Mastitis:
| Characteristics |
Engorgement |
Plugged Duct |
Mastitis |
| |
|
|
|
| Onset |
Gradual, immediately Postpartum |
Gradual, after feedings |
Sudden, after 10 days |
| Site |
Both breasts |
One breast |
Usually one breast |
Swelling
and Heat |
Entire breast |
May shift, little or no heat |
Localized, red, hot, swollen |
| Pain |
Entire breast |
Mild, but localized |
Intense, localized |
| Body Temperature |
<101˚F |
<101˚F |
<101˚F |
| Overall symptoms |
Feels well |
Feels well |
Flu-like symptoms |
Whether the breast is engorged, has a plugged duct, mastitis, the best advice is to continue breastfeeding or empty the breast with a pump. It is very important to treat with the appropriate antibiotics. If your baby is a healthy, full term infant, the breast milk remains safe. The drugs found most helpful in breast infections are medications like dicloxacillin or a cephalosporin. If you are severely allergic to penicillin, then clindamycin can be used. If you have a persistent infection after 48 hours of therapy your doctor may collect a mid-stream sample of your breast milk for culturing the specific organism.
An abscess can also be a complication of mastitis and is usually the result of delayed or inadequate treatment. Symptoms of a breast abscess may be similar to that of mastitis, but a moveable, compressible mass is also present. A persistent fever after initiating antibiotics may also suggest abscess. Treatment in these cases requires adequate drainage of the abscess with continued full therapeutic doses of antibiotics for 10 days. Sufficient healing usually occurs in 4 days.
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