From the Guidelines
Breast cellulitis treatment typically requires a course of antibiotics to combat the bacterial infection, with oral antibiotics such as dicloxacillin, cephalexin, or clindamycin being suitable options for most patients 1. For mild to moderate cases, oral antibiotics are often sufficient, while more severe infections or those with systemic symptoms like fever may require intravenous antibiotics initially, followed by oral antibiotics to complete the course. The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period 1. Some key points to consider in the treatment of breast cellulitis include:
- Elevation of the affected area to promote gravity drainage of edema and inflammatory substances
- Treatment of predisposing conditions, such as tinea pedis or venous eczema
- Use of warm compresses and supportive measures, such as a supportive bra, to alleviate symptoms
- Completion of the full course of antibiotics, even if symptoms improve quickly
- Monitoring for potential complications, such as abscess formation, and seeking medical reevaluation if symptoms worsen or fever persists beyond 48-72 hours of antibiotic therapy. It's also important to note that the choice of antibiotic should be active against streptococci, and in some cases, coverage against MRSA may be necessary 1. In general, breast cellulitis occurs when bacteria, typically Staphylococcus aureus or Streptococcus species, enter through a break in the skin and cause infection, leading to redness, swelling, warmth, and pain 1.
From the Research
Breast Cellulitis Treatment
- The treatment of breast cellulitis typically involves the use of antibiotics, with the choice of antibiotic depending on the severity of the infection and the presence of methicillin-resistant Staphylococcus aureus (MRSA) 2, 3, 4.
- A study published in 2010 found that trimethoprim-sulfamethoxazole and clindamycin were effective empiric therapies for outpatients with cellulitis in a community-associated MRSA-prevalent setting 2.
- Another study published in 2022 noted that the majority of non-purulent, uncomplicated cases of cellulitis are caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus, and that appropriate targeted coverage of this pathogen with oral antibiotics such as penicillin, amoxicillin, and cephalexin is sufficient 3.
- A decision analysis study published in 2007 found that cephalexin was the most cost-effective option for outpatient empiric therapy of cellulitis, but that clindamycin became a more cost-effective therapy at high likelihoods of MRSA infection 4.
- A study published in 2020 found that there was no association between the route of antibiotic administration (intravenous or oral) and clinical outcome, and that the duration of antibiotic therapy did not affect outcome 5.
- A systematic review and meta-analysis published in 2019 found that there was no evidence to support the superiority of any one antibiotic over another, and that antibiotics with activity against MRSA did not add an advantage 6.
Antibiotic Options
Route of Administration
- Oral antibiotics may be sufficient for uncomplicated cases of cellulitis 3, 5
- Intravenous antibiotics may be preferred in severe cases or in patients who have received antibiotics prior to trial entry 5