What is the treatment for non-lactation mastitis?

Treatment of Non-Lactational Mastitis

The treatment of non-lactational mastitis requires antibiotics effective against Staphylococcus aureus (such as dicloxacillin or cephalexin) as first-line therapy, along with symptomatic management and careful evaluation to rule out inflammatory breast cancer.

Differential Diagnosis

Non-lactational mastitis must be approached with caution as it requires different considerations compared to lactational mastitis:

• Inflammatory breast cancer - must always be ruled out in non-lactating women with inflammatory breast symptoms 1
• Bacterial infection - most common etiology (84.8% of cases) 2
• Mycobacterial infection - Mycobacterium tuberculosis (38.4%) and non-tuberculous mycobacteria (17.8%) 2
• Corynebacterium infection (20.5% of bacterial cases) 2

Diagnostic Approach

1. Clinical evaluation:

   • Assess for focal breast tenderness, erythema, warmth, and systemic symptoms
   • Note duration of symptoms (inflammatory breast cancer can present similarly)
   • Evaluate for underlying mass or abscess

2. Imaging:

   • Mammogram with accompanying ultrasound of the breast and regional lymph nodes 3
   • MRI may be indicated if parenchymal lesions are not detected by mammography or ultrasound 3

3. Tissue diagnosis:

   • Core biopsy to confirm diagnosis and rule out malignancy 3
   • Consider skin punch biopsy if inflammatory breast cancer is suspected 3

Treatment Protocol

1. Antibiotic Therapy

• First-line treatment:

  • Antibiotics effective against Staphylococcus aureus:
    • Dicloxacillin 500 mg orally four times daily for 10-14 days
    • Cephalexin 500 mg orally four times daily for 10-14 days 4

• For suspected MRSA:

  • Trimethoprim-sulfamethoxazole or clindamycin 4

• For mycobacterial infections:

  • Specific antimycobacterial regimens based on susceptibility testing 2

2. Symptomatic Management

• Pain control:
  • Non-steroidal anti-inflammatory drugs
  • Warm compresses to affected area

3. Monitoring and Follow-up

• Close follow-up is essential to:
  • Assess treatment response within 48-72 hours
  • Evaluate for abscess formation if symptoms persist
  • Rule out inflammatory breast cancer if no improvement occurs

Special Considerations

Abscess Management

If an abscess develops:

• Surgical drainage or needle aspiration is required 4
• Continue antibiotics after drainage

Warning Signs Requiring Urgent Evaluation

• Failure to respond to appropriate antibiotic therapy within 48-72 hours
• Progressive symptoms despite treatment
• Presence of suspicious features for inflammatory breast cancer:
  • Rapid onset of breast erythema, edema, peau d'orange
  • Erythema occupying at least one-third of the breast 3

Key Differences from Lactational Mastitis

1. Higher suspicion for malignancy in non-lactational cases
2. Different microbial etiology profile with higher rates of mycobacterial infections
3. Longer diagnostic time reported in some regions 2
4. May require more extensive imaging and diagnostic workup

Remember that any diagnosis of mastitis in a non-lactating patient should be viewed with suspicion, and inflammatory breast cancer must always be considered in the differential diagnosis 1.