Fever later in the puerperium is frequently due to mastitis. Staphylococcal species are the most common causes.
Breast abscesses are very rare and occasionally caused by methicillin-resistant Staphylococcus aureus.
Mastitis symptoms may include high fever and breast symptoms: erythema, induration, tenderness, pain, swelling, and warmth to the touch. Mastitis is different from the pain and cracking of nipples that frequently accompanies the start of breastfeeding.
Diagnosis of mastitis is clinical.
Treatment of Mastitis
Treatment of pain and complete emptying of breast milk
Initial therapy is to manage pain and swelling with cold compresses and analgesics, such as acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. when milk ducts are full,the breast should be completely emptied via breastfeeding or pumping. Fluid intake is encouraged. These measures are sufficient to treat many cases of mild or moderate mastitis.
Mastitis that does not respond to conservative measures or manifests as severe (eg, progressive erythema, signs of systemic illness) is treated with antibiotics aimed at Staphylococcus aureus, the most common causative pathogen. Examples are
Dicloxacillin 500 mg orally every 6 hours for 7 to 10 days
For women allergic to penicillin, cephalexin 500 mg orally 4 times a day or clindamycin 300 mg orally 3 times a day for 10 to 14 days
Erythromycin 250 mg orally every 6 hours is used less frequently.
If women do not improve and do not have an abscess, vancomycin 1 g IV every 12 hours or cefotetan 1 to 2 g IV every 12 hours to cover resistant organisms should be considered. Breastfeeding should be continued during treatment because treatment includes emptying the affected breast.
Breast abscesses are treated mainly with incision and drainage. Antibiotics aimed at S. aureus are often used.
It is not clear whether antibiotics aimed at methicillin-resistant S. aureus are necessary for treatment of mastitis or breast abscess.