Management of mastitis and breast engorgement in breastfeeding women

To identify the best management approaches to mastitis management in breastfeeding women and heavy breast engorgement in the early postnatal period.

We compared various international guidelines and reviews on mastitis management in breastfeeding women and breast engorgement treatment.

Effective milk removal is recommended as a first step in mastitis management. Active emptying of the breasts can prevent mastitis development in most cases. If it fails, antibiotics should be administered for 10-14 days with continuing breastfeeding. Russian guidelines recommend antibiotic therapy during 5-7 days with temporary bromocriptine-induced breastfeeding suppression. In case of heavy breast engorgement after lactation is initiated, Progesterone-containing gel can be administered. Application of the progesterone-containing gel on the breast skin improves swelling, and reduces engorgement and tenderness in 15-20 minutes.

Antibiotics with temporary suppression of breastfeeding are more effective than with continuing breastfeeding in mastitis management. The progesterone-containing gel is recommended on the 3rd-4th days after childbirth in heavy breast engorgement to prevent mastitis.