What is the recommended cefazolin regimen for the treatment of mastitis?

Cefazolin Regimen for Mastitis Treatment

The recommended cefazolin regimen for the treatment of mastitis is 1 gram intravenously every 8 hours for 7-10 days. 1

Dosing Details

• Standard adult dosing: 1 gram IV every 8 hours 1
• For severe infections: Consider increasing to 2 grams IV every 8 hours 1
• Pediatric dosing (if applicable): 33 mg/kg/dose IV every 8 hours 1
• Duration of therapy: 7-10 days, depending on clinical response 1

Rationale for Selection

• Cefazolin is effective against common mastitis pathogens, particularly Staphylococcus aureus, which is a frequent causative organism in mastitis 1, 2
• First-generation cephalosporins like cefazolin have demonstrated efficacy against staphylococcal infections in breast tissue 2
• Cefazolin provides good tissue penetration into breast tissue, allowing for effective treatment of the infection 1

Alternative Regimens

If cefazolin cannot be used (e.g., due to allergy or resistance):

• For penicillin-allergic patients:

  • Clindamycin: 600-900 mg IV every 8 hours 1
  • Vancomycin: 30 mg/kg/day in 2 divided doses (for severe beta-lactam allergy) 1

• For suspected MRSA:

  • Vancomycin: 30 mg/kg/day in 2 divided doses IV 1
  • Linezolid: 600 mg IV/PO every 12 hours 1

Monitoring and Follow-up

• Clinical response should be evident within 48-72 hours of initiating therapy 1
• If no improvement is seen within this timeframe, consider:
  • Obtaining cultures if not already done 1
  • Broadening antimicrobial coverage 1
  • Evaluating for abscess formation requiring drainage 1

Important Considerations

• Dosage adjustment: For patients with severe renal impairment (CrCl <30 mL/min), reduce the dose or extend the dosing interval 1
• Duration of therapy: Extend treatment if there is delayed clinical response or in complicated cases 1
• Supportive measures: In addition to antimicrobial therapy, encourage frequent breast emptying (breastfeeding or pumping) to prevent milk stasis 1

Potential Pitfalls

• Failure to drain any breast abscess if present will result in treatment failure regardless of appropriate antibiotic therapy 1
• Inadequate duration of therapy may lead to recurrence; complete the full course even if symptoms improve rapidly 1
• Cefazolin is not effective against MRSA; if MRSA is suspected or confirmed, alternative agents should be used 1