Trends in clinical management of lactational mastitis among women attending Australian general practice: a national longitudinal study using MedicineInsight, 2011-2022

Luke E. Grzeskowiak, Aline Kunnel, Sharinne B. Crawford, Meabh Cullinane, Lisa Helen Amir

Research output: Contribution to journalArticlepeer-review

9 Downloads (Pure)

Abstract

Objective 

To examine longitudinal trends in clinical management of lactational mastitis in women attending general practice. 

Design 

Open cohort study. 

Setting 

Australian general practice using data from MedicineInsight. 

Participants 

Women aged 18 to 44 years with one or more clinical encounters for lactational mastitis between January 2011 and July 2022. 

Primary and secondary outcome measures 

The primary outcome measure was the proportion of prescribed oral antibiotics based on the antibiotic type. Secondary outcome measures were the proportion of women prescribed other medications (eg, antifungals, lactation suppressants) or ordered selected clinical investigations including breast ultrasound, blood test, breast milk culture, nipple swab culture or breast aspirate. Outcomes were examined based on the calendar year and individual- or clinical practice-level characteristics. 

Results 

Among 25 002 women who had one or more clinical encounters related to mastitis, 90.9% were prescribed oral antibiotics. While the proportion of women prescribed an oral antibiotic remained consistent from 2011 to 2022 (91.1% vs 92.5%), there were changes in the proportion receiving prescriptions for di/flucloxacillin (46.1% vs 60.4%) and cefalexin (38.6% vs 26.5%). Fewer than 12% of women were clinically investigated for their mastitis encounter, most commonly a breast ultrasound (7.1%), followed by a selected blood test (3.8%). Requests for breast milk cultures, nipple swab cultures or breast aspirates occurred in less than 1.1% of individuals. Significant increases were evident with respect to ordering of all clinical investigations, with rates at least doubling between 2011 and 2022 (6.6% vs 14.7%). Large variability in clinical management was evident according to both individual- (eg, concessional status) and clinical practice-level characteristics (eg, remoteness). 

Conclusions 

Australian general practitioners commonly prescribe oral antibiotics to women with mastitis and largely in line with clinical guidelines. Their use of clinical investigations as part of mastitis management has increased over the last decade.

Original languageEnglish
Article numbere080128
Number of pages9
JournalBMJ Open
Volume14
Issue number5
DOIs
Publication statusPublished - 20 May 2024

Keywords

  • Epidemiology
  • MICROBIOLOGY
  • Pharmacology
  • Primary Care
  • Public health

Fingerprint

Dive into the research topics of 'Trends in clinical management of lactational mastitis among women attending Australian general practice: a national longitudinal study using MedicineInsight, 2011-2022'. Together they form a unique fingerprint.

Cite this