Adult Mastitis Treatment (Mastitis (Lactational Breast Infection))
MD-only online care for suspected lactational mastitis with safe antibiotic choices and breastfeeding-supportive guidance. $49 flat-fee video visits, no insurance required, available in 25+ states.
TeleDirectMD is physician-led. You will always see a board-certified MD, not a mid-level provider. We focus on uncomplicated lactational mastitis in adults and clearly identify when in-person breast or emergency evaluation is safer.
What Is Mastitis (Lactational Breast Infection)?
Lactational mastitis is inflammation and infection of breast tissue that occurs in adults who are breastfeeding or pumping. It usually develops when milk is not draining well from a part of the breast, allowing inflammation and bacteria to build up.
Typical mastitis causes a painful, firm area in one breast, often with redness, warmth, and fever or flu-like symptoms. Early recognition and treatment help relieve pain, reduce the risk of abscess formation, and support continued breastfeeding when safe.
TeleDirectMD focuses on uncomplicated mastitis in adults who are clinically stable. We use guideline-based oral antibiotics and supportive measures while identifying warning signs that require in-person evaluation, breast imaging, or possible drainage.
Mastitis Symptoms and Red Flags
Early mastitis can often be managed with telehealth when the adult is stable. Certain symptoms suggest abscess, severe infection, or a different diagnosis such as inflammatory breast cancer and require urgent in-person care.
| Symptom or pattern | What it suggests | Telehealth appropriate? | Red flag requiring in-person / ER care |
|---|---|---|---|
| Localized painful, firm area in one breast with redness and warmth | Typical presentation of early lactational mastitis | Often yes if symptoms are mild to moderate and the adult is otherwise stable | Rapidly worsening pain, expanding redness, or systemic illness despite supportive care |
| Fever, chills, and body aches with breast tenderness | Inflammatory response to mastitis or another infection | Sometimes; MD will assess stability and risk factors | High fever, rigors, confusion, or signs of sepsis require urgent in-person or ER evaluation |
| Wedge-shaped area of redness in one breast with continued milk production | Common pattern of segmental mastitis | Good fit for telehealth assessment and early antibiotic treatment when stable | Skin breakdown, necrosis, or rapidly spreading erythema concerning for more serious infection |
| Fluctuant, soft area or palpable lump that feels like a fluid pocket | Possible breast abscess | No as a stand-alone solution | Requires in-person evaluation and often ultrasound-guided or surgical drainage |
| Persistent breast redness and swelling that does not improve with antibiotics | Possible inflammatory breast cancer or alternative diagnosis | Telehealth can flag concern but is not sufficient | Needs expedited in-person breast imaging and specialist referral |
| Red streaks extending away from the breast toward the chest wall | Possible lymphangitis or more extensive infection | Limited; telehealth may direct immediate in-person care | Expanding streaks with fever and systemic symptoms should be evaluated urgently |
| Immunocompromised adult with mastitis symptoms | Higher risk of severe or atypical infection | Telehealth may provide interim guidance, but threshold for in-person care is low | Any systemic signs of illness or rapid progression require in-person evaluation |
| Breast pain with chest pain, shortness of breath, or feeling faint | Nonbreast cause such as cardiac or pulmonary issue may be present | No | Requires immediate emergency evaluation, not routine mastitis telehealth visit |
Conditions That Can Mimic or Overlap With Mastitis
TeleDirectMD physicians consider other breast conditions that can present with pain, redness, or swelling. Correct differentiation helps protect breast health and ensures serious diagnoses are not missed.
Breast Engorgement
Engorgement causes breasts to feel full, heavy, and tender, often in the early postpartum period or when feeding or pumping suddenly changes. Warmth and discomfort may be present, but fever and localized wedge-shaped erythema are less prominent. Optimizing milk removal and supportive care often improve symptoms without antibiotics.
Plugged or Clogged Duct
A plugged duct appears as a tender, localized lump that may be less red and systemic than mastitis. Improving drainage with frequent feeding, pumping, and gentle massage can relieve symptoms. Plugged ducts can progress to mastitis if not addressed, so close monitoring is important.
Breast Abscess
A breast abscess is a collection of pus in the breast tissue, usually evolving from untreated or severe mastitis. It often presents with a fluctuant mass, persistent fever, or lack of improvement on antibiotics. Abscesses require in-person imaging and drainage in addition to antibiotic therapy and are not appropriate for telehealth-only treatment.
Inflammatory Breast Cancer
Inflammatory breast cancer can mimic mastitis with redness, swelling, and warmth, but it typically does not resolve with antibiotics and may show skin changes such as peau d’orange. Adults with persistent symptoms despite appropriate therapy need timely in-person imaging and specialist evaluation.
Nipple Trauma and Dermatitis
Cracked nipples, eczema, or contact dermatitis can cause pain and superficial inflammation that complicate breastfeeding. While these conditions may co-exist with mastitis, their management involves latch assessment, gentle skin care, and sometimes topical therapy in addition to any needed antibiotics.
Nonlactational Breast Infections or Cysts
Nonlactational infections, inflamed cysts, or other breast masses can mimic mastitis symptoms. These conditions often require in-person breast examination, imaging, and sometimes biopsy to clarify the diagnosis and guide treatment.
When Mastitis Can Be Managed Through Telehealth
TeleDirectMD is best suited for adults with early or mild to moderate lactational mastitis symptoms who are otherwise stable. Suspected abscess, severe illness, or atypical features require in-person care.
When a TeleDirectMD Video Visit Is Appropriate
- Adult who is actively breastfeeding or pumping with new breast pain and focal tenderness.
- Localized breast redness and warmth limited to part of one breast.
- Low to moderate fever and flu-like symptoms in an otherwise stable adult.
- No obvious fluctuating mass or severe skin breakdown.
- Interested in continuing breastfeeding or pumping with support for safe positioning and drainage.
- Has access to local in-person care if symptoms fail to improve or worsen.
Red Flags Requiring In-Person or ER Care
- Suspected abscess with fluctuation, significant swelling, or draining pus from the breast.
- High fever, rigors, rapid heart rate, confusion, or signs of sepsis.
- Spreading redness that extends beyond the breast or is associated with severe pain.
- Persistent redness and swelling that does not improve after an appropriate course of antibiotics.
- History of breast cancer, strong family history with new breast changes, or concerning skin changes.
- Immunocompromised adult or significant comorbid conditions with new breast infection symptoms.
How TeleDirectMD Treats Lactational Mastitis in Adults
Treatment prioritizes clearing infection, relieving pain, and preserving breastfeeding when safe. TeleDirectMD uses oral antibiotics and supportive measures while avoiding unnecessary medications and clearly flagging situations that need in-person care.
Supportive Care and Breastfeeding Measures
- Encouraging frequent, effective emptying of the affected breast by breastfeeding or pumping, as tolerated.
- Positioning changes and gentle breast massage toward the nipple while feeding or pumping.
- Warm compresses before feeding or pumping and cool compresses afterward to relieve discomfort.
- Over-the-counter pain relievers such as acetaminophen or ibuprofen when appropriate.
- Reassurance that in most cases it is safe and beneficial to continue breastfeeding from the affected breast unless advised otherwise.
First-Line Antibiotic Treatment
For uncomplicated bacterial mastitis in adults, oral antibiotics targeting common organisms such as Staphylococcus aureus are usually recommended. TeleDirectMD uses guideline-aligned options and considers local resistance patterns when available.
- Beta-lactam antibiotics such as dicloxacillin or cephalexin as first-line in many cases.
- MRSA-active options such as clindamycin or trimethoprim-sulfamethoxazole when risk factors or local patterns support their use, with attention to infant age and feeding considerations.
- Typical treatment course of about 10–14 days, with early reassessment if symptoms fail to improve.
Dosing is individualized based on medical history, allergies, and concurrent medications. TeleDirectMD does not prescribe controlled substances for mastitis pain.
Stewardship and Safety Principles
- Confirming that symptoms fit a bacterial mastitis pattern before starting antibiotics.
- Documenting allergies, prior antibiotic exposure, and relevant comorbidities.
- Choosing the narrowest effective therapy and avoiding unnecessary broad-spectrum regimens.
- Recommending in-person imaging and possible drainage if symptoms suggest abscess or fail to improve as expected.
- No controlled substances are prescribed for mastitis visits through TeleDirectMD.
Common Medications Used for Mastitis in Adults
The table below summarizes typical adult oral antibiotic regimens used for uncomplicated lactational mastitis. TeleDirectMD physicians individualize therapy based on allergies, local resistance, and infant and parent factors.
| Medication | Dose | Duration | When it is used |
|---|---|---|---|
| Dicloxacillin | 500 mg orally 4 times daily | 10–14 days | First-line choice for uncomplicated mastitis in adults without penicillin allergy where methicillin-sensitive Staphylococcus aureus is likely. |
| Cephalexin | 500 mg orally 4 times daily | 10–14 days | Alternative first-line regimen for adults without severe beta-lactam allergy, targeting common gram-positive organisms. |
| Clindamycin | 300 mg orally 3–4 times daily | 10–14 days | Option for adults with penicillin allergy or when MRSA coverage is needed, with attention to gastrointestinal tolerance and infant considerations. |
| Trimethoprim-sulfamethoxazole (double strength) | 1 tablet orally 2 times daily | 10–14 days | Selected adults needing MRSA coverage when appropriate, typically avoiding use in certain infant age groups or conditions such as G6PD deficiency. |
| Ibuprofen | 400–600 mg orally every 6 hours as needed, with maximum daily limits | Short-term symptom control | Nonsteroidal anti-inflammatory drug used for pain and inflammation relief, when not contraindicated by kidney disease, bleeding risk, or other factors. |
These examples reflect common adult dosing patterns and may not be appropriate for every individual. TeleDirectMD clinicians select regimens that balance effectiveness, safety in lactation, and antibiotic stewardship, and will direct adults with severe or atypical disease to in-person care.
Home Care, Breastfeeding, and Return to Work
Most adults with uncomplicated mastitis can continue breastfeeding or pumping and remain at home while symptoms improve. Clear guidance helps protect both breast health and infant feeding.
Home Care and Feeding
- Continue breastfeeding or pumping from the affected breast as tolerated to improve drainage and recovery.
- Begin feeds on the less painful side first if needed to trigger let-down, then switch to the affected breast.
- Use warm compresses and gentle massage toward the nipple to help clear any contributing plugged ducts.
- Stay hydrated and rest as much as feasible while recovering.
Work, Daily Activities, and Follow-Up
- Many adults can continue light activities and work as they feel able, particularly once antibiotics and supportive care start helping.
- Heavy physical exertion may be uncomfortable while acute pain and systemic symptoms are present.
- Schedule follow-up if symptoms are not improving within 48–72 hours of appropriate therapy or if new concerning signs develop.
When to Seek In-Person Reassessment
- No improvement or worsening pain, redness, or fever after 48–72 hours of antibiotic therapy.
- New lump that feels fluctuant or concerning for abscess formation.
- Persistent breast changes after infection resolves, which may need imaging to rule out other diagnoses.
TeleDirectMD Mastitis Care: What to Expect
TeleDirectMD provides MD-only virtual urgent care for adults, with $49 flat-fee video visits available in 25+ states. Our physicians evaluate your breast symptoms, systemic signs, and breastfeeding pattern, then prescribe guideline-based oral antibiotics and supportive measures when appropriate. We do not prescribe controlled substances and will direct you to in-person primary care, obstetrics, breast imaging, or emergency care when abscess, inflammatory breast cancer, or severe infection is suspected.
Mastitis FAQs for Adults
These questions address how mastitis develops, how it is treated, whether breastfeeding can continue, and when in-person evaluation is needed.
Mastitis typically develops when milk is not draining well from part of the breast, leading to inflammation and sometimes bacterial overgrowth. Nipple trauma, skipped feeds, poor latch, or sudden changes in feeding or pumping patterns can all contribute.
In most uncomplicated cases, continuing to breastfeed or pump from the affected breast is safe and beneficial because it improves drainage and helps resolve mastitis. If your clinician has specific concerns about abscess or other conditions, they will give individualized guidance.
Many adults notice improvement in fever and overall flu-like symptoms within 24–48 hours of effective antibiotic therapy, with breast pain and redness improving over several days. If symptoms are not improving within 48–72 hours, you should be reassessed, often in person.
A plugged duct usually feels like a tender lump without significant redness or systemic symptoms and often improves with local measures such as massage and more frequent feeding. Mastitis typically includes more pronounced redness, warmth, and sometimes fever or body aches, and often requires antibiotics in addition to supportive care.
Many cases of early, uncomplicated mastitis can be evaluated and treated by video using history and visual inspection. If there is concern for abscess, severe infection, or a different diagnosis such as inflammatory breast cancer, we will recommend in-person breast examination and imaging.
Common mastitis antibiotics such as dicloxacillin and cephalexin are typically considered compatible with breastfeeding for most healthy term infants. Your MD will choose medications with lactation safety in mind and will discuss exceptions, such as premature infants or specific medications that warrant additional caution.
A breast abscess may cause a localized fluctuant lump, persistent or worsening pain and redness, and fever that does not improve with antibiotics. In that case, ultrasound and drainage are often needed, and in-person care is essential.
Inflammatory breast cancer can mimic mastitis with redness and swelling but does not improve with appropriate antibiotics and may cause skin thickening or dimpling. If your symptoms persist or recur after treatment, in-person breast imaging and specialist evaluation are important to rule out other diagnoses.
You should seek urgent in-person or emergency care for high fever with chills, feeling faint or confused, rapidly spreading breast redness, severe pain, or any concern for abscess or sepsis. Chest pain or shortness of breath should always be treated as an emergency.
No. TeleDirectMD does not prescribe controlled substances for mastitis. Pain control focuses on anti-inflammatory options such as ibuprofen when appropriate, along with improved breast drainage and supportive measures.