What is the treatment for a breast abscess?

From the Guidelines

The treatment for a breast abscess typically involves drainage of the pus collection, either through needle aspiration or surgical incision, combined with antibiotics. For smaller abscesses, ultrasound-guided needle aspiration is often the first approach, which may need to be repeated if the abscess recurs. Larger abscesses may require surgical incision and drainage under local or general anesthesia.

Key Considerations

• Antibiotic therapy usually includes dicloxacillin or cephalexin 500mg four times daily for 7-10 days, or clindamycin 300mg four times daily for patients with penicillin allergies, as recommended by guidelines for the treatment of skin and soft tissue infections 1.
• Pain management with acetaminophen or ibuprofen is also important.
• If the abscess is related to breastfeeding, women should continue to breastfeed or express milk from the affected breast to prevent milk stasis, which can worsen the infection.
• Warm compresses applied to the breast for 15-20 minutes several times daily can help improve blood circulation and promote healing.

Breast Abscess Formation

Breast abscesses form when bacteria, commonly Staphylococcus aureus, enter breast tissue through a crack in the nipple or via the milk ducts, causing an infection that progresses to a walled-off collection of pus if left untreated.

Treatment Approach

The approach to treatment should prioritize incision and drainage as the primary treatment for cutaneous abscesses, including breast abscesses, with antibiotic therapy considered based on the severity of the infection and the presence of systemic illness or comorbidities 1.

Antibiotic Selection

For empirical coverage of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in outpatients with skin and soft tissue infections, oral antibiotic options include clindamycin, trimethoprim-sulfamethoxazole, a tetracycline, and linezolid 1.

Duration of Therapy

The duration of antibiotic therapy should be individualized based on the patient’s clinical response, but typically ranges from 5 to 10 days for uncomplicated skin and soft tissue infections, and 7 to 14 days for more complicated infections 1.

From the FDA Drug Label

INDICATIONS AND USAGE Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. ... infections of the female pelvis and genital tract such as endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection. Serious skin and soft tissue infections; septicemia; intra- abdominal infections such as peritonitis and intra-abdominal abscess The answer to the question of whether an abscess can occur in the breast and its treatment is that breast abscess is not explicitly mentioned in the provided drug labels. However, clindamycin is used to treat serious skin and soft tissue infections, which could potentially include a breast abscess.

• The treatment for a breast abscess may involve clindamycin if the causative organisms are susceptible to it 2.
• The dosage for serious infections is 150 to 300 mg every 6 hours for adults 2.
• It is essential to note that the provided drug labels do not directly address the treatment of breast abscesses, and the decision to use clindamycin should be based on the judgment of a physician and the results of bacteriologic studies 2.

From the Research

Breast Abscess Treatment

• The treatment for a breast abscess varies, but it often involves antibiotics and drainage of the abscess 3, 4.
• Needle aspiration, either with or without ultrasound guidance, is recommended as the first line of treatment for breast abscesses 4.
• Ultrasound-guided percutaneous catheter placement may be considered as an alternative approach for larger abscesses 4.
• Surgical incision and drainage may be necessary for large, multiloculated, or long-standing abscesses, or if percutaneous drainage is unsuccessful 4.

Management of Lactational Breast Abscesses

• For breastfeeding women, needle aspiration is often preferred over incision and drainage to minimize scarring and promote continued breastfeeding 5.
• The use of antibiotics is also important in the treatment of lactational breast abscesses, but there is limited evidence on the most effective antibiotic regimen 5, 6.
• A study comparing needle aspiration to incision and drainage found that needle aspiration was associated with a shorter time to complete resolution of the abscess, but the evidence was not conclusive due to limitations in the data 5.

Best-Practice Care Pathway

• A best-practice care pathway for the management of mastitis and breast abscesses has been proposed, which includes uniformity of antibiotic prescribing, ultrasound assessment, and admission rates 7.
• The pathway also recommends percutaneous aspiration rather than incision and drainage, and specialist follow-up to improve patient outcomes 7.