Prescribing antibiotics for women with mastitis

Mastitis, or breast infection, is a common issue for breastfeeding women. Around one in five experience it during the first six months after giving birth, and most will visit their GP for advice.
 
Current guidelines from Melbourne’s Royal Women’s Hospital (RWH) on prescribing antibiotics for mastitis align with the Therapeutic Guidelines, and vary according to symptoms and stages.
 
If women get symptoms of mastitis during the early postpartum period and they have nipple damage, it is likely to be a breast infection with Staphylococcus aureus, and it is recommended to start antibiotics immediately.
 
If women get symptoms later (for example, once their baby is sleeping through the night) – such as painful breast, hard or red area of the breast, feeling unwell – general measures are recommended to begin with. These include feeding or expressing more frequently, applying cold to the breast to reduce swelling, and taking analgesia such as ibuprofen.
 
If there is no improvement after 24 hours, it is recommended to start antibiotics.
 
According to one expert, however, it is unclear to what extent Australian GPs are following these guidelines, or how they make decisions on prescribing medications for treating breastfeeding women with mastitis.
 
‘In practice, GPs would usually prescribe an antibiotic and either start immediately, if the patient is very unwell or has nipple damage, or try the steps [as advised by the Therapeutic Guidelines] and start antibiotics later if no improvement,’ Women’s health GP, La Trobe University Professor and RWH breastfeeding specialist, Lisa Amir, told newsGP.
 
Advice about antibiotic use has changed over the years for some infections, according to Professor Amir, but has remained ‘pretty consistent’ for the antibiotic treatment of mastitis.
 
‘Yet I occasionally hear of breastfeeding women prescribed antibiotics outside the guidelines for mastitis,’ she said.
 
Professor Amir has had an interest in mastitis since another woman in her new mother’s group in the 1980s was given incorrect advice to stop breastfeeding when she had mastitis.
 
‘I am interested in understanding how GPs make decisions about treating mastitis and what they think about using guidelines, in particular the Therapeutic Guidelines,’ she said.
 
This led Professor Amir to embark on her research project with La Trobe University, ‘Understanding antibiotic prescribing for mastitis in breastfeeding women: A mixed-method study’, for which she received a 2020 Therapeutic Guidelines Limited (TGL) / RACGP Foundation Research Grant.
 
The project is a mixed-method approach designed to enable an understanding of Australian GPs’ current practices when caring for women with mastitis. It includes general practice data using the NPS MedicineInsight database.
 
The Foundation Grant will also enable interstate collaboration with South Australia’s Flinders University by providing funding for a data analyst to use the dataset to describe management of mastitis in general practice.
 
‘Currently, we have little research about how doctors make decisions when prescribing for breastfeeding women,’ Professor Amir said.
 
‘How do they weigh up the risks and benefits?’
 
The research team is examining how GPs prescribe and their use of guidelines, with the hope the findings will provide evidence to support improvements in the guidelines and education for health professionals in the future.
 
‘Improving the management of this common breastfeeding problem for new mothers will ensure fewer complications, like breast abscess development or hospital admission, and better mental and physical health for mothers and their children,’ Professor Amir said.
 
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antibiotics breastfeeding mastitis women’s health