From the Guidelines
For a breast abscess with a tract to the chest wall and free air on CT scan, I strongly recommend empiric broad-spectrum antibiotic therapy with coverage for skin flora, anaerobes, and gram-negative organisms, such as piperacillin-tazobactam plus vancomycin, as outlined in the guidelines by the Infectious Diseases Society of America 1. This approach is necessary due to the complex nature of the infection, which likely involves mixed flora including staphylococci, streptococci, anaerobes, and occasionally gram-negative organisms.
- The recommended regimen is piperacillin-tazobactam 3.37 g every 6–8 h IV, plus vancomycin 30 mg/kg/d in 2 divided doses IV, as suggested for mixed infections 1.
- Alternatively, other options for mixed infections include imipenem-cilastatin, meropenem, or ertapenem, with specific dosages outlined in the guidelines 1.
- For patients with penicillin allergy, meropenem 1 g IV every 8 hours is a suitable alternative.
- It is essential to initiate antibiotic therapy immediately and continue for at least 10-14 days, with transition to oral antibiotics based on clinical improvement and culture results.
- Surgical drainage is also crucial alongside antibiotic therapy, as the presence of a chest wall tract and free air indicates a complex infection that likely won't resolve with antibiotics alone.
- Regular monitoring of clinical response, inflammatory markers, and follow-up imaging may be necessary to ensure resolution of the infection.
- Once culture results are available, therapy should be narrowed to target the specific pathogens identified, taking into account the possibility of resistant strains such as MRSA, which may require the addition of vancomycin 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Antibiotic Treatment for Breast Abscess
The choice of antibiotics for treating a breast abscess, especially with a tract to the chest wall and free air on computed tomography (CT) scan, is crucial for effective management. Considering the complexity of the infection, the antibiotics should cover a broad spectrum of bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), which is commonly found in breast abscesses 2, 3.
Recommended Antibiotics
- Ciprofloxacin with Clindamycin: This combination is recommended as initial empirical therapy for breast abscesses, especially when MRSA is suspected 2.
- Piperacillin/Tazobactam: This antibiotic combination has shown efficacy against a wide range of bacteria, including Pseudomonas aeruginosa, and could be considered for complex infections 4, 5.
- Clindamycin and Gentamicin: This combination is effective for treating upper genital tract infections and could be an alternative for breast abscesses, although its use might be limited by the potential for gentamicin toxicity 5.
Considerations
- MRSA Prevalence: The high prevalence of MRSA in breast abscesses underscores the need for antibiotics that are effective against this organism 2, 3.
- Antibiotic Resistance: The choice of antibiotics should be guided by local antibiograms and susceptibility patterns to ensure efficacy 2.
- Non-Operative Treatment: For some breast abscesses, non-operative treatment with needle aspiration and oral antibiotics may be a viable alternative to surgical drainage 6.
Bacterial Coverage
The selected antibiotics should provide coverage against the common pathogens involved in breast abscesses, including: