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Meta-Analysis
. 2013 Feb 28;2013(2):CD005458.
doi: 10.1002/14651858.CD005458.pub3.

Antibiotics for mastitis in breastfeeding women

Shayesteh Jahanfar  1 , Chirk Jenn Ng, Cheong Lieng Teng
Affiliations
Meta-Analysis

Antibiotics for mastitis in breastfeeding women

Shayesteh Jahanfar et al. Cochrane Database Syst Rev. .

Abstract

Background: Mastitis can be caused by ineffective positioning of the baby at the breast or restricted feeding. Infective mastitis is commonly caused by Staphylococcus aureus. The prevalence of mastitis in breastfeeding women may reach 33%. Effective milk removal, pain medication and antibiotic therapy have been the mainstays of treatment.

Objectives: This review aims to examine the effectiveness of antibiotic therapies in relieving symptoms for breastfeeding women with mastitis with or without laboratory investigation.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2012), contacted investigators and other content experts known to us for unpublished trials and scanned the reference lists of retrieved articles.

Selection criteria: We selected randomised controlled trials (RCTs) and quasi-RCTs comparing the effectiveness of various types of antibiotic therapies or antibiotic therapy versus alternative therapies for the treatment of mastitis.

Data collection and analysis: Two review authors independently assessed trial quality and extracted data. When in dispute, we consulted a third author.

Main results: Two trials met the inclusion criteria. One small trial (n = 25) compared amoxicillin with cephradine and found no significant difference between the two antibiotics in terms of symptom relief and abscess formation. Another, older study compared breast emptying alone as 'supportive therapy' versus antibiotic therapy plus supportive therapy, and no therapy. The findings of the latter study suggested faster clearance of symptoms for women using antibiotics, although the study design was problematic.

Authors' conclusions: There is insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for the treatment of lactational mastitis. There is an urgent need to conduct high-quality, double-blinded RCTs to determine whether antibiotics should be used in this common postpartum condition.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Amoxicillin versus cephradine, Outcome 1 Symptom improvement assessed by clinician.
2.1
2.1. Analysis
Comparison 2 Antibiotic therapy with breast emptying versus no treatment, Outcome 1 Symptom improvement assessed by clinician and continuous breastfeeding.
3.1
3.1. Analysis
Comparison 3 Antibiotic therapy with breast emptying versus breast emptying alone, Outcome 1 Symptom improvement assessed by clinician and continuous breastfeeding.
4.1
4.1. Analysis
Comparison 4 Sensitivity analyses: antibiotic therapy versus no treatment, Outcome 1 Assuming that in both groups both breasts are infected: symptom improvement assessed by a clinician.
4.2
4.2. Analysis
Comparison 4 Sensitivity analyses: antibiotic therapy versus no treatment, Outcome 2 Assuming that in both groups 60% of women have 2 breasts infected and 40% 1 infected.
5.1
5.1. Analysis
Comparison 5 Sensitivity analyses: antibiotic therapy versus breast emptying, Outcome 1 Assuming that in both groups both breasts are infected: symptom improvement assessed by a clinician.
5.2
5.2. Analysis
Comparison 5 Sensitivity analyses: antibiotic therapy versus breast emptying, Outcome 2 Assuming that in both groups 60% of women have 2 breasts infected and 40% 1 infected.
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

Hager 1996 {published data only}
    1. Hager DW, Barton RJ. Treatment of sporadic acute puerperal mastitis. Infectious Diseases in Obstetrics and Gynecology 1996;4(2):97‐101. - PMC - PubMed
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References to studies excluded from this review

Amir 2004b {published data only}
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Zhou 2009 {published data only}
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References to other published versions of this review

Jahanfar 2009
    1. Jahanfar S, Ng CJ, Teng CL. Antibiotics for mastitis in breastfeeding women. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD005458.pub2] - DOI - PubMed
Ng 2005
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