Bacterial mastitis presents with fever or shivering and the presence of two local signs of inflammation (redness, swelling, heat, or pain), most often localized to the external superior quadrant of one breast. The most commonly encountered bacteria are Staphylococcus aureus, followed by Streptococcus, Staphylococcus epidermidis, and E. coli. In rare circumstances, a culture of the abscess liquid is performed, but generally, treatment is empirical.

Nonpharmacologic measures, such as cold or warm compresses and more frequent breast-feeding should be encouraged. If a woman is not breast-feeding, it is important to empty the infected breast with a pump to prevent milk stasis. Several antibiotics can be used (Table 47-8). Analgesics (e.g., acetaminophen, ibuprofen, or naproxen) can be used to relieve pain.44

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