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, along with appropriate diagnostic workup to rule out inflammatory breast cancer.

Diagnosis and Evaluation

Non-lactational mastitis differs significantly from lactational mastitis in its etiology, presentation, and management approach. When evaluating a patient with suspected non-lactational mastitis:

• Conduct thorough breast examination to assess for:

  • Erythema, warmth, tenderness
  • Presence of underlying mass
  • Skin changes (peau d'orange, edema)
  • Nipple abnormalities or discharge

• Key diagnostic considerations:

  • Duration of symptoms (inflammatory breast cancer presents with rapid onset within 6 months) 1
  • Extent of erythema (inflammatory breast cancer typically affects at least one-third of the breast) 1
  • Response to initial treatment (lack of response warrants further investigation)

Treatment Algorithm

First-Line Treatment

1. Antibiotic therapy:

   • First choice: Dicloxacillin or cephalexin (effective against Staphylococcus aureus) 2
   • Duration: 10-14 days
   • Consider methicillin-resistant S. aureus (MRSA) coverage if risk factors present or increasing local prevalence 2

2. Symptomatic management:

   • Anti-inflammatory medications for pain and inflammation
   • Warm compresses to affected area
   • Supportive bra to minimize movement and discomfort

Monitoring and Follow-up

• Reassess within 48-72 hours to evaluate response to treatment
• If no improvement occurs within 48 hours:
  • Consider changing antibiotics
  • Evaluate for abscess formation
  • Urgent diagnostic workup to rule out inflammatory breast cancer

Warning Signs Requiring Further Investigation

• Failure to respond to appropriate antibiotic therapy within 48-72 hours 3
• Presence of a palpable mass
• Skin changes resembling inflammatory breast cancer:
  • Erythema occupying at least one-third of the breast
  • Edema or peau d'orange appearance
  • Flattening, crusting, or retraction of the nipple 1

Complications and Management

Breast Abscess

If an abscess develops:

• Surgical drainage or needle aspiration is required 2
• Continue antibiotic therapy
• Consider ultrasound to guide drainage

Inflammatory Breast Cancer Considerations

• Any diagnosis of mastitis in a non-lactating woman should raise suspicion for inflammatory breast cancer 3

• Diagnostic criteria for inflammatory breast cancer include:

  • Rapid onset of breast erythema, edema, and/or peau d'orange
  • Duration less than 6 months
  • Erythema affecting at least one-third of the breast
  • Pathological confirmation of invasive carcinoma 1

• If inflammatory breast cancer is suspected:

  • Obtain core biopsy of breast tissue
  • Consider skin punch biopsy (at least two) 1
  • Imaging studies including mammogram and ultrasound 1

Key Differences from Lactational Mastitis

Non-lactational mastitis differs from lactational mastitis in several important ways:

• Higher risk of underlying malignancy
• May be associated with periductal mastitis, duct ectasia, or other breast pathology
• Often requires more aggressive diagnostic workup
• May require longer courses of antibiotics

Remember that any non-lactational mastitis that does not respond promptly to appropriate antibiotics should trigger an urgent evaluation for inflammatory breast cancer, which can present with similar symptoms but requires immediate oncological management.