Insufficient evidence on effectiveness of antibiotics for lactational mastitis

Clinical question: 
How effective are antibiotics in relieving symptoms of lactational mastitis in breastfeeding women?
Bottom line: 
There is insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for the treatment of lactational mastitis. One small trial (n=25) compared amoxicillin with cephradine and found no significant difference between the 2 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 suggested faster resolution of symptoms for women using antibiotics, although the study design was problematic.
Caveat: 
The review only contains 2 trials involving 125 participants. Only 1 of the studies adequately described the method of allocation concealment. Generation of randomisation sequence was not reported in either study.
Context: 
Infective mastitis is commonly caused by Staphylococcus aureus. The incidence of mastitis in breastfeeding women may reach 33%. The condition is associated with decreased milk secretion, decreased productivity, and difficulties caring for the baby.
Review CD#: 
CD005458
PEARLS No: 
153
Date: 
April, 2009
Authored by: 
Brian R McAvoy