Bacterial mastitis and abscesses are generally not absolute indications to pump and dump (1).  Continued breastfeeding or pumping on the affected breast is recommended for both infectious and noninfectious mastitis in the vast majority of  cases. Discontinuation of breastfeeding or abrupt weaning increases the inflammatory response and will worsen mastitis (2). Concerns with specific types of infections may warrant a disruption of direct feeding at the breast or feeding expressed human milk as noted below. Additionally, standard contact precautions and prophylaxis protocols should be followed when managing dyads with infectious diseases.

Most antibiotics used for treatment of mastitis are safe for infant consumption and are not an absolute indication to pump and dump although infants should be monitored for possible side effects such as diarrhea, vomiting, rash, or other possible side effects. Trimethoprim-sulfamethoxazole should be avoided while breastfeeding a G6PD-deficient infant or in the first month postpartum for infants with documented jaundice or at risk for jaundice such as the premature or ill infant population. For more information, see the section on Antibacterial Agents.

Special considerations for specific infections are noted below (2).

For more detailed information and references on specific medications, please refer to LactMed, e-lactancia, Infant Risk, or Mother to Baby.

Group B Strep (GBS) is a commonly occurring bacteria in the environment and may rarely cause severe infections in newborns and young infants. While early-onset neonatal GBS (EOGBS) infections have been greatly reduced through intrapartum antibiotic prophylaxis (IAP), late-onset newborn GBS (LOGBS) disease rates have not changed and clear sources of infection have not been identified. Human milk is one proposed source of GBS causing LOGBS disease in infants, but the evidence for this as a possible source is not very strong at this time based on several literature reviews as noted below (3, 4).

A 2021 retrospective case-control study of LOGBS disease in infants in 4 health systems over 11 years found similar breastfeeding rates between infants with LOGBS disease (78% were breastfeeding at diagnosis) and matched controls (74% were breastfeeding). This study concluded that there is no significant difference in breastfeeding rates between infants with LOGBS disease and matched controls. They also concluded that breastmilk culture and eradication of GBS for the lactating parent and/or infant should be considered with recurrent LOGBS with or without other risk factors, such as prematurity (5).

While there are case reports and small case series suggesting a link between GBS+ breastmilk with or without symptomatic mastitis and LOGBS disease, there is not strong evidence of an association between the two per 2 recently published literature reviews (3, 4). Most lactating parents with GBS+ breastmilk will not have infants with LOGBS disease so routine culture and eradication are not warranted prophylactically or with a single episode of LOGBS disease. Recurrent LOGBS disease and LOGBS in premature infants or other vulnerable populations may warrant breastmilk culture, and if positive for GBS, pasteurization of breastmilk. If the parent or infant is colonized with GBS and the infant has recurrent LOGBS disease, then the need to treat the dyad to eliminate colonization should be discussed as well (3,4).

There is no absolute indication to pump and dump with GBS+ mastitis. With recurrent LOGBS disease, families should be engaged in shared decision making about the need to culture breastmilk, disrupt breastfeeding, pump and pasteurize breastmilk, and/or eradicate GBS in the lactating parent and infant.

Brucellosis transmission through human milk is exceedingly rare with less than 10 case reports in the last 50 years based on one systematic review of the literature. Of the 7 cases identified in breastfeeding infants, 2 milk cultures were positive for Brucella and the remainder could not be definitively linked to human milk transmission (6). By the time the parent is diagnosed with this condition, the infant has already been exposed and there is no need to interrupt breastfeeding or the use of the parent’s milk (2). There is no absolute indication to pump and dump with this rare infectious disease. Consult with local infectious disease specialists to further discuss management of this infection.

Tuberculosis (TB) mastitis is an exceedingly rare condition that requires special considerations for the breastfeeding dyad. Lactating individuals with active untreated TB are not expected to transmit TB via breastmilk unless TB mastitis is present. TB mastitis usually involves one breast with associated axillary lymph node swelling with or without a draining sinus tract, painless mass, or edema of the breast. TB breast infections may occur in isolation or may be a part of disseminated disease. TB breast infections, including TB mastitis, are an indication to pump and dump until the lesion or mastitis heals (or for at least 2 weeks after the lactating individual starts multi-drug therapy for TB) (2). Consult with local infectious disease specialists to further discuss management of this rare infection.