From the FDA Drug Label
Major Abscess 55 (21%) / 43 (16%) 59 (22%) / 65 (22%) 114 (21%) / 108 (19%)
*Comparator: vancomycin (1 g IV q12h) or an anti-staphylococcal semi-synthetic penicillin (i.e., nafcillin, oxacillin, cloxacillin, or flucloxacillin; 4 to 12 g/day IV in divided doses).
The recommended IV antibiotic regimen for the treatment of a breast abscess is daptomycin for injection (4 mg/kg IV q24h) or vancomycin (1 g IV q12h) or an anti-staphylococcal semi-synthetic penicillin (i.e., nafcillin, oxacillin, cloxacillin, or flucloxacillin; 4 to 12 g/day IV in divided doses) 1.
- Key points:
- Daptomycin for injection (4 mg/kg IV q24h)
- Vancomycin (1 g IV q12h)
- Anti-staphylococcal semi-synthetic penicillin (4 to 12 g/day IV in divided doses)
- Note: Patients known to have bacteremia at baseline were excluded from the trials.
From the Research
The recommended intravenous antibiotic regimen for treating a breast abscess is ciprofloxacin with clindamycin as initial empirical therapy, as suggested by the most recent study 2. This approach is based on the fact that MRSA is the most common organism seen in breast abscesses, and the first-line treatment of antibiotics, such as amoxicillin clavulanate, is mostly resistant. Some key points to consider when treating breast abscesses include:
- Coverage for Staphylococcus aureus (including MRSA) and Streptococcus species is essential
- Antibiotic therapy alone is usually insufficient for breast abscesses larger than 3cm, which generally require drainage via needle aspiration or surgical incision
- Cultures should be obtained during drainage to guide targeted antibiotic therapy
- Patients should also be assessed for risk factors such as diabetes or immunosuppression that might necessitate longer treatment courses
- The use of vancomycin or daptomycin may be considered if MRSA is suspected or confirmed, as suggested by other studies 3, 4 However, the most recent and highest quality study 2 recommends ciprofloxacin with clindamycin as the preferred initial empirical therapy for breast abscesses. It's also important to note that the management of breast abscesses should be based on the individual patient's needs and the specific characteristics of the abscess, as outlined in other studies 5, 6.