Which is the most appropriate next step in managing a woman with postpartum mastitis?

The most appropriate next step in managing a woman with postpartum mastitis involves using an antibiotic that is effective against the most common pathogens involved, especially Staphylococcus aureus, while also ensuring that the woman can continue breastfeeding.

Dicloxacillin is a penicillinase-resistant penicillin that is particularly effective against Staphylococcus species and is a well-established treatment for mastitis. Importantly, it is safe for use during breastfeeding, which is crucial since continuing to breastfeed can help drain the infected area and reduce symptoms more rapidly. This approach also supports the mother's milk supply and maintains the mother-infant bonding experience.

While other antibiotics listed might treat bacterial infections, they either are not the best choice for mastitis or require discontinuation of breastfeeding, which can be detrimental to both the mother and the infant. For instance, amoxicillin and clindamycin are not first-line treatments for mastitis, and ciprofloxacin is less commonly used for this specific indication and is also not recommended for breastfeeding mothers due to potential risks to the infant.