QuestionSBA
QuestionChoice
Clindamycin has activity against common Gram-positive bacteria responsible for skin and soft tissue infections, but would not be a first line option to treat uncomplicated lactational mastitis
34047
c
Clindamycin 300mg PO TDS for 7 days
QuestionChoice
flucloxacillin is recommended first line to treat lactational mastitis
34045
a
Flucloxacillin 500mg PO QDS for 14 days
QuestionChoice
All tetracycline antibiotics are contraindicated in breastfeeding due to the risk of irreversible teeth discolouration in the infant
34048
d
Doxycycline 200mg PO OD for 14 days
QuestionChoice
Ciprofloxacin is a fluoroquinolone antibiotic with a mid to broad spectrum of activity. It is not generally used to treat lactational mastitis
34046
b
Ciprofloxacin 400mg PO BD for 7 days
QuestionChoice
Erythromycin is an acceptable second line agent to treat lactational mastitis
34049
e
Erythromycin 500mg PO QDS for 14 days
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2753
Lactational mastitis
Topic
76
Obstetrics and Gynaecology
6820
Case Presentation: A 24 year old woman has had pain in her left breast for the last three days. She is currently 6 weeks post-partum, and while she has been taking simple oral analgesia and continuing to express milk at the advice of her health visitor, her symptoms remain unresolving. She has no known drug allergies.


**O/E**

Right breast grossly normal, no palpable lumps. Left breast area of erythema at 3 o’ clock position from the areola, measuring approximately 2 x 3 cm. Warm and very tender to touch, but no nipple fissuring or fluctuant lumps on palpation.

Temperature 37.1°C. HR 70, RR 12.

Question: Select the most appropriate management at this stage.
a