An active infective process is confirmed by a milk culture which is organised by your GP, takes a few days to be performed and is not always reliable. Many antibiotics have anti-inflammatory properties, and this may explain why women experience relief, or reduction in mastitis symptoms, when taking these (Mitchell, 2022).

There is evidence to show that impaired milk flow, maternal stress, genetic predisposition and sleep deprivation can cause breast inflammation in the absence of infection (Ingman, 2014). Mammary dysbiosis, or disruption of the milk microbiome, from a complex interplay of factors has also been shown to contribute to the development of mastitis (Mitchell, 2022).

There is insufficient evidence to support the effectiveness of antibiotic therapy for mastitis (Jahanfar, 2013) and current recommendations state to reserve antibiotics for bacterial mastitis (Mitchell, 2022), with bacterial mastitis representing a progression from inflammatory mastitis.

In cases of infection, common mastitis causing bacteria have thick, slimy barriers around them (called biofilms), which obstruct milk flow. Therapeutic ultrasound has been shown to breakdown biofilms (in other parts of the body) (Hosoien, 2010), allowing antibiotics to be effective.

Try to adhere to the standard treatment and take anti-inflammatories for the first 3 days, and then see if you need antibiotics. If you are unsure, please don’t change anything until you have had a chat with Emma.