Postpartum mastitis is much more common than nonpuerperal mastitis. The pathophysiology involves obstruction of the duct, inspissation of milk, and secondary bacterial invasion. The patient has localized warmth and tenderness of the affected breast. She may even have systemic symptoms and signs, such as fever, malaise, and leukocytosis. The condition is so painful that it may threaten continuation of breast-feeding. Most authors recommend a conservative approach to mastitis in postpartum patients. Analgesia, warm or cold compresses, and increased pumping of the affected breast have all been recommended. The most commonly identified organism is S. aureus. Antibiotics are frequently recommended for lactational mastitis, and the best choice is a penicillinase-resistant penicillin. However, if abscess is present, anaerobes may be involved, and clindamycin is a better choice. Lactating mothers question whether it is safe to continue to nurse with mastitis. Clearly, emptying of the breast, either by a mechanical pump or manually, leads to quicker resolution of the condition. The affected breast milk will not harm the baby, although, with breast abscess, ongoing nursing on the unaffected side with expression of milk on the affected side seems to be the best management approach. 13
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