What antibiotic is recommended for treating breast abscess and mastitis?

From the Guidelines

For treating breast abscess and mastitis, amoxicillin/clavulanic acid is recommended as a first-line antibiotic, especially in breastfeeding patients, due to its effectiveness and safety profile 1.

Key Considerations

• The choice of antibiotic should target Staphylococcus aureus, the most common causative organism in breast infections.
• Amoxicillin/clavulanic acid is a suitable option for breastfeeding patients requiring systemic antibiotics.
• Treatment duration is usually 7-10 days, but may vary depending on the patient's clinical response.
• In addition to antibiotics, treatment should include continued breastfeeding or breast milk expression, warm compresses, adequate hydration, and pain management with acetaminophen or ibuprofen.
• For breast abscesses, ultrasound-guided drainage may be necessary alongside antibiotic therapy.

Important Factors

• Patient allergies, such as penicillin allergy, should be considered when selecting an antibiotic.
• The presence of systemic illness, fever, or severe symptoms may require prompt medical reevaluation to consider alternative diagnoses or resistant organisms.
• The use of antibiotics should be individualized based on the patient's clinical response and local epidemiology.

Additional Recommendations

• Cultures from abscesses and other purulent infections are recommended to guide antibiotic therapy and detect potential resistance patterns 1.
• Empirical therapy for CA-MRSA may be considered in patients with severe or extensive disease, rapid progression, or associated cellulitis 1.

From the Research

Antibiotic Treatment for Breast Abscess and Mastitis

The choice of antibiotic for treating breast abscess and mastitis is crucial for effective management.

• The predominance of Staphylococcus aureus in breast abscesses allows for a rational choice of antibiotic without waiting for bacteriological culture results 2.
• Many antibiotics are secreted in milk, but penicillin, cephalosporins, and erythromycin are considered safe for use during breastfeeding 2.
• Antibiotics such as antistaphylococcal antibiotics are traditionally used in the management of breast abscesses, often in conjunction with incision and drainage of pus 2.

Management Approaches

Different management approaches are recommended, including:

• Repeated needle aspirations and suction drainage for breast abscesses, which has supplanted open surgery as the first line of treatment 2.
• Incision and drainage of a breast abscess can be done under local anesthesia, with continued drainage at home by the mother 3.
• Needle aspiration, either with or without ultrasound guidance, is recommended as the first line treatment for breast abscesses, with potential benefits including superior cosmesis and shorter healing time 4.

Treatment Considerations

Treatment considerations include:

• The use of antibiotics in conjunction with aspiration or drainage procedures 2, 4.
• The importance of frequent nursing and massaging or stripping the breast to keep it empty of milk or pus, in addition to antibiotic treatment 3.
• The need for individualized treatment approaches, as no central treatment guidelines exist for the management of breast infections 5.