From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci Anaerobes: Serious skin and soft tissue infections; Streptococci: Serious skin and soft tissue infections. Staphylococci: Serious skin and soft tissue infections.
The organisms to cover for breast abscess include:
- Anaerobes
- Streptococci
- Staphylococci Based on the information provided in the drug label for clindamycin 1, these organisms are commonly associated with serious skin and soft tissue infections, which would include breast abscess.
Cefazolin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections as described in INDICATIONS AND USAGE Gram-Positive Aerobes Staphylococcus aureus (including beta-lactamase-producing strains) Staphylococcus epidermidis Streptococcus pyogenes, Streptococcus agalactiae, and other strains of streptococci Streptococcus pneumoniae
The organisms to cover for breast abscess also include:
- Staphylococcus aureus
- Streptococcus pyogenes
- Streptococcus agalactiae Based on the information provided in the drug label for cefazolin 2, these organisms are susceptible to cefazolin.
From the Research
Breast abscesses are most commonly caused by Staphylococcus aureus, including methicillin-resistant strains (MRSA), and treatment should cover these organisms. The most recent and highest quality study 3 found that MRSA was the predominant organism in breast abscesses, and that first-line empirical antibiotics such as amoxicillin-clavulanate were often resistant.
Key Organisms and Treatment
- Staphylococcus aureus (including MRSA)
- Streptococcus species
- Anaerobes
- Empiric antibiotic therapy should cover these organisms, with options including:
- Ciprofloxacin and clindamycin as initial empirical therapy for suspected MRSA 3
- Trimethoprim-sulfamethoxazole (TMP-SMX) DS twice daily, clindamycin 300-450 mg orally four times daily, or doxycycline 100 mg twice daily for suspected MRSA
Drainage and Cultures
- Drainage is essential for abscesses larger than 3 cm, either through needle aspiration or incision and drainage
- Cultures should be obtained during drainage to guide targeted antibiotic therapy 4, 5
Breastfeeding and Treatment
- Lactating women can continue breastfeeding from the unaffected breast while expressing milk from the affected side until symptoms resolve
- Treatment options should be chosen with consideration for the safety of the breastfeeding infant 6
Conclusion Not Applicable - Direct Answer Only
The recommended empiric antibiotic therapy for breast abscesses should cover Staphylococcus aureus, including MRSA, with options including ciprofloxacin and clindamycin.