The most efective treatment has not been reported Oahanfar, 2013). hus, the initial antimicrobial choice is influenced by the current experience with staphylococcal infections at a given institution. Dicloxacillin, 500 mg orally four times daily, may be started empirically. Erythromycin is given to women who are penicillin sensitive. If the infection is caused by resistant, penicillinase-producing staphylococci or if resistant organisms are suspected while awaiting the culture results, then vancomycin, clindamycin, or trimethoprim-sulfamethoxazole is given (Sheield, 2013). Although clinical response may be prompt, treatment is recommended for 10 to 14 days.
Marshall and coworkers (1975) demonstrated the importance of continued breastfeeding. hey reported that of 65 women with mastitis, the only three who developed abscesses were among the 15 women who quit breastfeeding. Vigorous milk expression may be suicient treatment alone (homsen, 1984). Sometimes the infant will not nurse on the inlamed breast. his probably is not related to any changes in the milk taste but is secondary to engorgement and edema, which can make the areola harder to grip. Pumping can alleviate this. When nursing bilaterally, it is best to begin suckling on the uninvolved breast. This allows let-down to commence before moving to the tender breast.
In resource-poor countries, breastfeeding in women infected with the human immunodeficiency virus (HIV) is not contraindicated. In the setting of mastitis or breast abscess, it is recommended to stop feeding from the infected breast. his is because HIV RNA levels increase in afected breast milk. These levels return to baseline after symptoms resolve (Semrau, 2013).
In a population-based study of nearly 1.5 million Swedish women, the incidence of breast abscess was 0.1 percent (Kvist, 2005). An abscess should be suspected when defervescence does not follow within 48 to 72 hours of mastitis treatment or when a mass is palpable. Again, sonographic imaging is valuable. Breast abscesses can be large, and in one case report, 2 L of pus were released (Martic, 2012). Traditional therapy is surgical drainage, which usually requires general anesthesia. he incision ideally is placed along Langer skin lines for a cosmetic result (Stehman, 1990). In early cases, a single incision over the most dependent portion of luctuation is usually suicient. Multiple abscesses, however, require several incisions and disruption of loculations. The resulting cavity is loosely packed with gauze, which should be replaced at the end of 24 hours by a smaller pack.
A more recently used technique that is less invasive is sonographically guided needle aspiration using local analgesia. his has an 80-to 90-percent success rate (Geiss, 2014; Schwarz, 2001). In a randomized trial, Naeem and colleagues (2012) compared surgical drainage and aspiration. They found aspiration resulted in quicker healing at 8 weeks, 77 versus 93 percent, respectively.
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