From the Research
Breast abscesses typically require a combination of antibiotics and drainage for effective treatment, with the most recent and highest quality study suggesting the use of broad-spectrum antibiotics such as clindamycin and flucloxacillin for empiric coverage 1. The recommended antibiotics include dicloxacillin 500 mg orally four times daily, cephalexin 500 mg orally four times daily, or clindamycin 300-450 mg orally four times daily for 7-10 days. For more severe cases or patients with systemic symptoms, intravenous options include cefazolin 1-2 g every 8 hours or clindamycin 600-900 mg every 8 hours. In cases of MRSA concern, consider trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily) or doxycycline (100 mg twice daily) 2. Some key points to consider when treating breast abscesses include:
- Antibiotics alone are insufficient; drainage is essential, either through needle aspiration for smaller abscesses or surgical incision and drainage for larger ones.
- Patients should continue breastfeeding from the unaffected breast and can resume feeding from the affected breast once drainage is complete and antibiotics have been started.
- Warm compresses before feeding and cold compresses after can help manage pain.
- These infections typically occur when bacteria enter through cracked nipples or milk ducts, with Staphylococcus aureus being the most common pathogen, which explains the antibiotic choices targeting this organism 3, 4. It's also important to note that breast infections are frequently polymicrobial, with a wide variety of organisms isolated, suggesting the need for broad-spectrum coverage until culture results become available 1. Based on the most recent study, an evidence-based treatment guideline is required and should be formulated in close collaboration with microbiology specialists 5, 1.