Response to Baeza et al. re: “Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022”

Mitchell, Katrina B.; Johnson, Helen M.; Rodríguez, Juan Miguel Díaz; Eglash, Anne; Scherzinger, Charlotte; Widmer, Kyle; Berens, Pamela D.; Miller, Brooke

doi:10.1089/bfm.2022.29226.abm

Cited by 2 publications

(9 citation statements)

References 3 publications

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“…Patients eligible for a trial of conservative treatment are those with mild systemic symptoms, focal breast findings, and signs of improvement without antibiotic therapy within 24 to 48 hours. 2,7 Conservative treatment consists of rest, continuing physiologic breastfeeding/milk expression, over-the-counter nonsteroidal and analgesic medications, and monitoring for symptom progression. Physiologic breastfeeding consists of feeding infants on cue or expressing the volume of milk that the child needs.…”

Section: Symptoms Risk Factors and Treatmentmentioning

confidence: 99%

“…Patients with worsening symptoms, with severe local or systemic symptoms at onset, and those not improving with 24 to 48 hours of conservative measures should be treated with antibiotics. 2 The common bacterial pathogens that cause lactational mastitis and guide treatment are Staphylococcus, in particular S aureus, and Streptococcus. Treatment with a standard antibiotic regimen, such as dicloxacillin or cephalexin, is typically prescribed for 10 to 14 days (Figure).…”

Section: Symptoms Risk Factors and Treatmentmentioning

confidence: 99%

“…Approximately 3% to 11% of people with mastitis develop an abscess. 2 The most common systemic symptoms of lactational mastitis are malaise (87%), fever (82%), and chills (78%). 2,6 Differential diagnoses of these findings include breast engorgement, "plugged ducts" (focal ductal narrowing and stromal edema), galactocele (consisting of obstructed milk in a cyst-like cavity), malignancy, and, less commonly, idiopathic granulomatous mastitis or periductal mastitis.…”

Section: Symptoms Risk Factors and Treatmentmentioning

confidence: 99%

“…2 The most common systemic symptoms of lactational mastitis are malaise (87%), fever (82%), and chills (78%). 2,6 Differential diagnoses of these findings include breast engorgement, "plugged ducts" (focal ductal narrowing and stromal edema), galactocele (consisting of obstructed milk in a cyst-like cavity), malignancy, and, less commonly, idiopathic granulomatous mastitis or periductal mastitis. Additionally, extended periods of breast fullness may produce transient erythema and edema from distension of alveolar cells; this physiologic response should not be considered an acute onset of mastitis.…”

Section: Symptoms Risk Factors and Treatmentmentioning

confidence: 99%

“…Infection, inflammation, and alterations in intrinsic bacterial microbiome have been implicated as etiologic factors. 2,4 Characteristics associated with the development of lactational mastitis include nipple injury, breastfeeding difficulties, hyperlactation, breast pump use, and history of mastitis. 1,2 The traditional approach to management of mastitis consists of antibiotic treatment and frequent breast emptying to prevent "milk stasis," defined as accumulation of milk in the breast.…”

Section: Symptoms Risk Factors and Treatmentmentioning

confidence: 99%

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Risk Factors, Symptoms, and Treatment of Lactational Mastitis

Louis‐Jacques

Berwick

Mitchell³

2023

JAMA

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Section: Symptoms Risk Factors and Treatmentmentioning

confidence: 99%

Section: Symptoms Risk Factors and Treatmentmentioning

confidence: 99%

Section: Symptoms Risk Factors and Treatmentmentioning

confidence: 99%

Section: Symptoms Risk Factors and Treatmentmentioning

confidence: 99%

Section: Symptoms Risk Factors and Treatmentmentioning

confidence: 99%

See 3 more Smart Citations

Risk Factors, Symptoms, and Treatment of Lactational Mastitis

Louis‐Jacques

Berwick

Mitchell³

2023

JAMA

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Does the Academy of Breastfeeding Medicine’s Clinical Protocol #36 ‘The Mastitis Spectrum’ promote overtreatment and risk worsened outcomes for breastfeeding families? Commentary

Douglas

2023

Int Breastfeed J

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Background In 2022 the Academy of Breastfeeding Medicine (ABM) published Clinical Protocol #36: The Mastitis Spectrum, which aims to update clinical approaches to management of benign lactation-related breast inflammation. The protocol has been timely because of the exponential increase in knowledge about the human milk microbiome over the past decade. This Commentary aims to continue respectful debate amongst clinicians and researchers within the Academy of Breastfeeding Medicine and more broadly, confident that we share a fundamental commitment to promote breastfeeding and support the well-being of lactating women, their infants and their families. Analysis Although Clinical Protocol #36 offers advances, it does not fulfil the principles of best practice implementation science for translation of evidence into clinical guidelines. Clinical Protocol #36 inaccurately represents studies; misrepresents theoretical models as proven aetiologies; does not consistently attribute sources; does not reliably apply the SORT taxonomy; and relies upon single case reports. As a result, various recommendations in Clinical Protocol #36 lack an evidence-base or credible underlying theoretical model. This includes recommendations to use ‘lymphatic drainage’ massage, therapeutic ultrasound, and oral lecithin. Similarly, based on a contestable theoretical model which is presented as fact, Clinical Protocol #36 makes the recommendation to either reduce frequency of milk removal or to maintain current frequency of milk removal during an episode of breast inflammation. Although Clinical Protocol #36 limits this advice to cases of ‘hyperlactation’, the diagnosis ‘hyperlactation’ itself is undefinable. As a result, this recommendation may put breastfeeding women who present with breast inflammation at risk of worsened inflammation and decreased breast milk production. Conclusion Clinical Protocol #36 offers some advances in the management of breast inflammation. However, Clinical Protocol #36 also exposes clinicians to two international trends in healthcare which undermine health system sustainability: overdiagnosis, including by over-definition, which increases risk of overtreatment; and antibiotic over-use, which worsens the crisis of global antimicrobial resistance. Clinical Protocol #36 also recommends unnecessary or ineffective interventions which may be accessed by affluent patients within advanced economies but are difficult to access for the global majority. The Academy of Breastfeeding Medicine may benefit from a review of processes for development of Clinical Protocols.

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Response to Baeza et al. re: “Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022”

Cited by 2 publications

References 3 publications

Risk Factors, Symptoms, and Treatment of Lactational Mastitis

Risk Factors, Symptoms, and Treatment of Lactational Mastitis

Does the Academy of Breastfeeding Medicine’s Clinical Protocol #36 ‘The Mastitis Spectrum’ promote overtreatment and risk worsened outcomes for breastfeeding families? Commentary

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