Interventions for preventing mastitis after childbirth

Background Despite the health benefits of breastfeeding, initiation and duration rates continue to fall short of international guidelines. Many factors influence a woman's decision to wean; the main reason cited for weaning is associated with lactation complications, such as mastitis. Objectives To assess the effects of preventive strategies for mastitis and the subsequent effect on breastfeeding duration. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (8 August 2012). Selection criteria We included randomised controlled trials of interventions for preventing mastitis in postpartum breastfeeding women. Data collection and analysis We independently identified relevant studies and assessed the trial quality. We contacted trial authors for missing data and information as appropriate. Main results We included five trials (involving 960 women). In three trials of 471 women, we found no significant differences in the incidence of mastitis between use of antibiotics and no antibiotics (risk ratio (RR) 0.43; 95% confidence interval (CI) 0.11 to 1.61; or in one trial of 99 women comparing two doses (RR 0.38; 95% CI 0.02 to 9.18). We found no significant differences for mastitis in three trials of specialist breastfeeding education with usual care (one trial); anti-secretory factor cereal (one trial); and mupirocin, fusidic acid ointment or breastfeeding advice (one trial). Generally we found no differences in any of the trials for breastfeeding initiation or duration; or symptoms of mastitis. Authors' conclusions There was insufficient evidence to show effectiveness of any of the interventions, including breastfeeding education, pharmacological treatments and alternative therapies, regarding the occurrence of mastitis or breastfeeding exclusivity and duration. While studies reported the incidence of mastitis, they all used different interventions. Caution needs to be applied when considering the findings of this review as the conclusion is based on studies, often with small sample sizes. An urgent need for further adequately powered research is needed into this area to conclusively determine the effectiveness of these interventions.