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Lactational mastitis — CCFP MCQ

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ModerateWomen's health/OB/GYNLactational mastitisCCFP

A breastfeeding mother 3 weeks postpartum has a painful erythematous wedge-shaped area on one breast, fever 38.5°C, and malaise. The infant is feeding well. On examination, there is no fluctuance. What is the most appropriate next step in management?

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Correct answer: B — Continue breastfeeding or milk expression, start anti-staphylococcal antibiotics, and reassess for abscess if symptoms do not improve

Answer B is correct. In uncomplicated lactational mastitis with systemic signs, continuing breastfeeding or milk expression promotes drainage and resolution while antibiotic therapy directed at Staphylococcus aureus treats the infection. Canadian Family Physician guidelines affirm this management approach. Option A prematurely ceases breastfeeding and risks complications. Option C (mammography) is unnecessary without suspicion of malignancy or failure to respond to therapy. Option D (topical antifungal) is inappropriate, as candida is unlikely and does not explain fever. Option E (reassurance alone) is unsafe when systemic features are present; antibiotics are indicated.

Reference: Canadian Family Physician, “A mother with Salmonella mastitis and a baby with Salmonella bacteremia,” 2021, https://www.cfp.ca/content/67/10/747