QuestionSBA
QuestionChoice
She is haemodynamically stable and apyrexial and therefore intravenous antibiotics are not indicated at this point
31786
d
IV erythromycin
QuestionChoice
This patient has a known penicillin allergy and therefore flucloxacillin is contraindicated
31784
b
Oral flucloxacillin
QuestionChoice
This patient has a known penicillin allergy and therefore co-amoxiclav is contraindicated
31787
e
IV co-amoxiclav
QuestionChoice
This patient has a known penicillin allergy and therefore flucloxacillin is contraindicated
31785
c
IV flucloxacillin
QuestionChoice
As a penicillin allergic patient, this is the most appropriate antibiotic. As she is haemodynamically stable and apyrexial, oral antibiotics are appropriate
31783
a
Oral erythromycin
Concept
Chapter
# Summary
 

Mastitis is an inflammation of the breast, often associated with lactation in postpartum women, referred to as puerperal mastitis. Key signs and symptoms include localised pain, tenderness, redness and heat in the breast, along with systemic symptoms such as fever, rigours, myalgia, fatigue, nausea and headache. Diagnosis is primarily clinical. Ultrasound may be used if a breast abscess is suspected. Management strategies focus on reassurance about continued breastfeeding, advice on milk removal, analgesia, antibiotics, and in severe cases, surgical intervention.
 

# Definition
 

Mastitis is the inflammation of the breast tissue, which can be with or without an infection. When associated with lactation in postpartum women, the condition is specified as puerperal mastitis. Alternatively, mastitis can be seen in women who are not breastfeeding.
 

# Epidemiology
 

Non-lactational mastitis is significantly less common than lactational mastitis, and its most common in women with immunodeficiency and diabetes.  
 

# Aetiology
 
Mastitis unrelated to pregnancy and breastfeeding is typically due to obstruction of the ducts from cellular debris. This can result in a local inflammatory response in non-infectious mastitis. 

In infectious mastitis, bacteria from the skin can then enter the ducts, causing inflammation and may progress to peri-areolar abscesses. The most common causative pathogen is Staphylococcus aureus. 

Risk factors for non-lactational mastitis include:

- Cigarette smoking
- Nipple rings 
- Diabetes mellitus
- Immunocompromise 
 

# Signs and Symptoms
 

Mastitis diagnosis is primarily clinical, based on characteristic local and systemic symptoms.
 

 -  Localised symptoms: Painful, tender, red, and hot breast.
 -  Systemic symptoms: Fever, rigours, myalgia, fatigue, nausea, and headache.
 -  Additional information: The condition is usually unilateral and tends to present within the first week postpartum.
 

In some cases, mastitis may develop into a breast abscess, manifesting as a fluctuant, tender mass with overlying erythema.
 

# Differential Diagnosis
 

The differential diagnosis for mastitis should include other conditions that also cause breast pain and inflammation:
 

 -  **Breast abscess**: Fluctuant mass, tenderness, overlying erythema, systemic signs of infection.
 -  **Inflammatory breast cancer**: Swelling, skin changes resembling orange peel, nipple inversion, axillary lymphadenopathy.
 -  **Breast engorgement**: Typically bilateral and associated with milk stasis, painful, and tense breasts.
 

# Investigations
 

While the diagnosis of mastitis is primarily clinical, further investigations may be necessary in certain circumstances.
 

 -  Ultrasound: Utilised to identify a potential abscess, appearing as a collection of pus.
 -  Additional information: Early referral to secondary care is vital if an abscess is suspected.
 

# Management
 

Managing mastitis involves multiple strategies:
 

 -  Provide analgesia to manage symptoms (i.e. paracetamol, ibuprofen)
	 -  Warm and cold compresses may also help.
 -  Antibiotics may be considered if acute pain, severe symptoms or symptoms lasting more than 12-24 hours, fever or positive cultures 
	 -  Flucloxacillin or clindamycin for those with penicillin allergy
	 -  Treatment is indicated for 10-14 days.
 -  In cases where the condition does not improve, consider intravenous antibiotics (i.e. vancomycin) or ultrasound to evaluate for the presence of a breast abscess.
 -  Patients may also benefit from antifungal therapy (i.e. nystatin) for concomitant nipple candidiasis 

 
#  Complications
 
Complications of mastitis include:
 
 - Breast abscess
 - Recurrence:
	 - More common if treatment is delayed or too short in duration 
 

# NICE Guidelines
 
[NICE CKS on mastitis and breast abscess](https://cks.nice.org.uk/topics/mastitis-breast-abscess/)

# References

[BMJ Best Practice Mastitis and Breast Abscess](https://bestpractice.bmj.com/topics/en-gb/1084)

[Patient Info Benign Breast Diseas](https://bestpractice.bmj.com/topics/en-gb/1084) 

[NHS Mastitis](https://www.nhs.uk/conditions/mastitis/)
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345
Lactational Breast abscess
Topic
55
Breast Disease
6357
In breastfeeding women with a breast abscess, oral erythromycin is a suitable antibiotic choice for those allergic to penicillin.
A 33-year-old woman presents to the out of hours general practitioner with a tender, fluctuant mass in her left breast, with associated erythema of the overlying skin. She is currently breast feeding. A breast abscess is confirmed on ultrasound and percutaneous drainage is performed uneventfully.

Her observations are as follows:

Pulse 80 beats per minute

Respiratory rate 17 breaths per minute

Blood pressure 115/75mmHg

Temperature 37.2°

She looks otherwise well, and is alert and orientated. Her renal function and liver function is within normal limits and she has an allergy to penicillin

Which of the following is the most appropriate antibiotic therapy?
a