Mastitis Organism-Specific Therapy 

Mastitis Organism-Specific Therapy 

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Organism-specific regimens for mastitis are provided below, including those for Staphylococcus aureus, coagulase-negative staphylococci, staphylococci, streptococci, and Peptostreptococcus.

Routine cases:

If beta-lactam allergy:

When clinical improvement is apparent, transition the patient from IV to oral antibiotics for completion of a 10- to 14-day course. [1, 2, 3, 4, 5]

Initial or routine cases:

For rare strains or refractory cases:

Routine:

The following drugs have been approved by the FDA for treatment of soft-tissue infections but have not yet been assessed specifically for efficacy in treating breast infections.

When clinical improvement is apparent using ceftaroline, transition the patient from IV to oral antibiotics for completion of a 10- to 14-day course. [1, 2, 3, 8, 9] When using dalbavancin or oritavancin, additional antibiotics are not required except as indicated for failure of clinical resolution.

Fungal mastitis should be suspected when pain is disproportional to clinical findings. Pain is often described as “shooting from nipple through the breast to the chest wall.” Concurrent yeast infections, such as oral thrush or diaper dermatitis, are common. Evidence regarding treatment is conflicting. [7]

Mild infections:

Moderate-to-severe infections:

Fluconazole 400 mg IV/PO (initial dose), followed by 200 mg daily, for a minimum of 10 days. Single large doses are ineffective. Infants are not adequately treated with the amount of fluconazole that is passed via breast milk and therefore should be treated independently with 6-12 mg/kg initial dose, followed by 3-6 mg/kg/day for a minimum of 10 days.

Consider the following:

If lactating:

Spencer JP. Management of mastitis in breastfeeding women. Am Fam Physician. 2008 Sep 15. 78(6):727-31. [Medline].

Jahanfar S, Ng CJ, Teng CL. Antibiotics for mastitis in breastfeeding women. Cochrane Database Syst Rev. Jan 21 2009. (1):CD005458.

World Health Organization.Geneva; 2000. Mastitis: Causes and Management. Available at http://whqlibdoc.who.int/hq/2000/WHO_FCH_CAH_00.13.pdf.. Accessed: July 12, 2011.

Auwaerter P. Mastitis. Hopkins Guides. Available at https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540333/all/Mastitis. 2018 Jan 3; Accessed: 2018 Jan 18.

Amir LH. ABM clinical protocol #4: Mastitis, revised March 2014. Breastfeed Med. 2014 Jun. 9(5):239-43. [Medline]. [Full Text].

McCurdy S, Lawrence L, Quintas M, Woosley L, Flamm R, Tseng C, et al. In Vitro Activity of Delafloxacin and Microbiological Response against Fluoroquinolone-Susceptible and Nonsusceptible Staphylococcus aureus Isolates from Two Phase 3 Studies of Acute Bacterial Skin and Skin Structure Infections. Antimicrob Agents Chemother. 2017 Aug 24. 61(9):e00772-17. [Medline]. [Full Text].

Baxdela (delafloxacin) prescribing information [package insert]. Lincolnshire, IL: Melinta Therapeutics, Inc. 2017 Jun. Available at [Full Text].

Becker K, Ballhausen B, Köck R, Kriegeskorte A. Methicillin resistance in Staphylococcus isolates: The “mec alphabet” with specific consideration of mecC, a mec homolog associated with zoonotic S. aureus lineages. Int J Med Microbiol. 2014 Jun 28. [Medline].

Parriott AM, Chow AL, Arah OA. Inadequate research on methicillin-resistant Staphylococcus aureus risk among postpartum women. Expert Rev Anti Infect Ther. 2013 Nov. 11(11):1127-30. [Medline].

Andrew C Miller, MD Associate Professor, Chief, Research Division, Department of Emergency Medicine, The Brody School of Medicine at East Carolina University

Andrew C Miller, MD is a member of the following medical societies: American College of Academic International Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Alexandra R King, PharmD, DABAT Clinical Pharmacist, Emergency Medicine and Toxicology, Vidant Medical Center

Alexandra R King, PharmD, DABAT is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Clinical Pharmacy, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Mastitis Organism-Specific Therapy 

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