What is the recommended dose of cephalexin (a first-generation cephalosporin) for the treatment of mastitis?

Cephalexin Dosage for Mastitis Treatment

For the treatment of mastitis, cephalexin should be administered at a dose of 500 mg orally four times daily for 7-14 days. 1

Rationale for Cephalexin Use in Mastitis

Mastitis is typically caused by Staphylococcus aureus, which requires appropriate antibiotic coverage. Cephalexin, a first-generation cephalosporin, is highly effective against methicillin-susceptible Staphylococcus aureus (MSSA), making it an appropriate choice for treating mastitis 2.

Evidence-Based Dosing Recommendations:

• Adult dosing: 500 mg orally four times daily 1
• Duration: 7-14 days (typical course for skin/soft tissue infections)
• Pediatric dosing: Not applicable for mastitis (primarily affects lactating women)

Clinical Considerations

Pathogen Coverage

Cephalexin provides excellent coverage against the most common causative organism in mastitis:

• Effective against Staphylococcus aureus (primary pathogen in mastitis)
• Also covers Streptococcus species that may occasionally cause mastitis

Important Clinical Notes:

• Continue breastfeeding during treatment, as this helps resolve the infection and does not pose risk to the infant 2
• If no improvement within 48 hours, consider:
  1. Possible methicillin-resistant S. aureus (MRSA)
  2. Development of breast abscess requiring drainage
  3. Need for alternative antibiotics

Alternative Antibiotic Options

If cephalexin is contraindicated (e.g., severe penicillin allergy):

• Clindamycin: 300-450 mg orally four times daily 1
• Dicloxacillin: 500 mg orally four times daily 1

Prevention of Complications

The most serious complication of mastitis is breast abscess, which can be prevented by:

1. Early initiation of appropriate antibiotics
2. Continued breastfeeding to maintain milk flow
3. Complete emptying of the breast through effective breastfeeding technique 2

If an abscess develops despite antibiotic therapy, surgical drainage or needle aspiration will be required, but breastfeeding can usually continue 2.

Common Pitfalls to Avoid

1. Stopping breastfeeding: This can worsen the condition by causing milk stasis
2. Inadequate duration of therapy: Premature discontinuation may lead to recurrence
3. Failing to address breastfeeding technique: Consulting with a lactation specialist may be necessary to prevent recurrence
4. Not considering MRSA: If no improvement with first-line therapy, consider MRSA coverage
5. Missing an abscess: Persistent symptoms despite appropriate antibiotics should prompt evaluation for abscess

Cephalexin remains a first-line treatment for mastitis due to its excellent activity against the most common causative organisms and its favorable safety profile during lactation.