From the Guidelines
Breast cellulitis requires prompt antibiotic treatment, and for mild to moderate cases, oral antibiotics such as dicloxacillin, cephalexin, or clindamycin for 5 days are recommended, as indicated by the Infectious Diseases Society of America guidelines 1.
Diagnosis and Management
The diagnosis of breast cellulitis is primarily clinical, and cultures of blood or cutaneous aspirates, biopsies, or swabs are not routinely recommended 1. However, in patients with severe infection or those who are immunocompromised, cultures may be considered to guide antibiotic therapy 1.
Antibiotic Therapy
The choice of antibiotic should cover streptococci, and options include penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, cephalexin, or clindamycin 1. For patients with systemic signs of infection, hospitalization and intravenous antibiotics may be necessary 1.
Duration of Therapy
The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period 1.
Supportive Care
In addition to antibiotic therapy, patients should rest, apply warm compresses to the affected area, wear a supportive bra, take pain relievers like acetaminophen or ibuprofen as needed, and stay well-hydrated 1. Breastfeeding mothers can typically continue nursing, as this helps drain the breast and prevent milk stasis.
MRSA Consideration
MRSA is an unusual cause of typical cellulitis, and coverage for MRSA may be prudent in cellulitis associated with penetrating trauma, especially from illicit drug use, purulent drainage, or with concurrent evidence of MRSA infection elsewhere 1.
Key Points
- Breast cellulitis requires prompt antibiotic treatment
- Oral antibiotics such as dicloxacillin, cephalexin, or clindamycin for 5 days are recommended for mild to moderate cases
- Hospitalization and intravenous antibiotics may be necessary for severe cases or those with systemic symptoms
- Patients should rest, apply warm compresses, wear a supportive bra, take pain relievers, and stay well-hydrated
- Breastfeeding mothers can typically continue nursing
- MRSA coverage may be necessary in certain cases, such as penetrating trauma or purulent drainage.
From the Research
Definition and Diagnosis of Breast Cellulitis
- Breast cellulitis is an acute infection of the dermal and subcutaneous layers of the skin, often occurring after a local skin trauma 2
- It classically presents with erythema, swelling, warmth, and tenderness over the affected area 2
- Diagnosis can be confirmed through history, local characteristics of the affected area, systemic signs, laboratory tests, and skin biopsy 2
Treatment of Breast Cellulitis
- Most patients can be treated as an outpatient with oral antibiotics, with dicloxacillin or cephalexin being the oral therapy of choice when methicillin-resistant Staphylococcus aureus is not a concern 2
- For implant-based breast reconstruction, initial cellulitis amenable to oral antibiotics should be treated with oral fluoroquinolones as a first-line treatment 3
- If the regimen fails, intravenous imipenem or gentamicin and vancomycin should be initiated 3
Delayed Breast Cellulitis
- Delayed breast cellulitis is characterized by the late onset of breast erythema, edema, tenderness, and warmth, often occurring months after breast conservation therapy 4, 5
- Risk factors for delayed breast cellulitis include obesity, ecchymoses, T stage, presence and aspiration of a breast hematoma/seroma, removal of >5 axillary lymph nodes, and arm lymphedema 4
- Treatment for delayed breast cellulitis often involves empirical antibiotics, with 92% of patients responding to treatment 4
Antibiotic Selection and Efficacy
- There is no evidence to support the superiority of any one antibiotic over another for the treatment of cellulitis 6
- Antibiotics with activity against methicillin-resistant Staphylococcus aureus do not add an advantage 6
- The use of intravenous antibiotics over oral antibiotics and treatment duration of longer than 5 days are not supported by evidence 6