Management of mastitis and breast engorgement in breastfeeding women

Objective: To identify the best management approaches to mastitis management in breastfeeding women and heavy breast engorgement in the early postnatal period. Methods: We compared various international guidelines and reviews on mastitis management in breastfeeding women and breast engorgement treatment. Results: 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. Conclusions: 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.