Literature review for - Flourish Paediatrics

Three studies reported on the occurrence rate of mastitis during the postpartum period.
However due to the lack of high quality studies there was insufficient evidence to form a
body of evidence statement. The three studied that were reviewed indicated a high occurrence
rate of mastitis early in the postpartum period A cohort study in Australia reported 51% of
mastitis cases occurred within the first two weeks postpartum (Fetherston 1997). The cohort
study by Scott and colleagues found 53% of initial mastitis episodes and 43% of all episodes
occurred during the first four weeks postpartum (Scott, Robertson et al. 2008). Consistent
with these rates are the results from a cohort study by Amir and colleagues that found 54% of
mastitis episodes occurred in first 4 weeks (Amir, Forster et al. 2007) .
All studies, with the exception of one, did not associate mastitis with poorer breastfeeding
outcomes. The majority of studies found no significant difference between incidence of
mastitis and breastfeeding duration, and some even found women who had had mastitis were
more likely to breastfed for longer than those who did not have mastitis (Vogel, Hutchison et
al. 1999; Scott, Robertson et al. 2008). The one study that linked mastitis with poorer
breastfeeding outcomes reported 18% of the women who had stopped breastfeeding by three
months cited mastitis as the reason for stopping (Fetherston 1997). Alarmingly, the cohort
study conducted by Scott and colleagues found a small portion of women (approximately
10%) were inappropriately advised to either stop breastfeeding from the affected breast, or
altogether when they had mastitis (Scott, Robertson et al. 2008).
The Cochrane review by Jahanfar and colleagues aimed to examine the effectiveness of
antibiotic therapies in the treatment of mastitis. After a thorough research of the literature two
RCTs met the inclusion criteria (Jahanfar, Ng et al. 2009). One study compared two different
antibiotics (amoxicillin vs. cephradine) and found no differences between the two antibiotics
for symptom relief. The second study compared no treatment, breast emptying, and antibiotic
therapy, with breast emptying suggesting more rapid symptom relief with antibiotics.
Jahanfar & Ng concluded there is very little evidence on the effectiveness of antibiotic
therapy, and more research is needed (Jahanfar, Ng et al. 2009). A narrative review by Abou-
Dakn and colleagues investigated 16 studies on the recommendations for the diagnosis and
therapy of breast diseases during lactation also concluded that there is insufficient evidence to
confirm or refute the effectiveness of the different therapies for the treatment of mastitis
(Abou-Dakn, Richardt et al. 2010).
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