Intravenous ceftriaxone plus clindamycin reduces breast abscess formation in severe lactational mastitis

Abstract

Objective: Lactational mastitis can progress to local abscess formation if not treated promptly. The study aims to understand whether the use of intravenous cephalosporin plus clindamycin could reduce breast abscess formation when preferred as a first-line treatment instead of oral penicillin. Method: Patients who admitted to our outpatient clinic with sign and symptoms of lactational mastitis were recruited retrospectively for the study. Patients who had abscess formation on admittance were excluded. Patients were categorized into two groups according to antibiotic preference as the group I with intravenous ceftriaxone plus clindamycin and group II with oral penicillin. Groups were compared according to abscess formation in follow-up by physical examination and ultrasound. Results: A total of 64 patients with severe lactational mastitis were included. In group I (n=29), only one breast abscess with MSSA was developed. However, seven cases of breast abscess were developed in the second group (n=35). MRSA (n=4), MSSA (n=1), gram-negative bacilli (n=1) and no organism (n=1) were cultured in pus among group II. The prevalence of abscess in group I is found to be significantly lower in comparison to the control group in 12 weeks follow-up (p=0.049). Conclusions: MRSA and gr (-) bacilli are the significant agents in persistent breast abscess formation, which are resistant to oral penicillin or first/second-line cephalosporin. The ceftriaxone plus clindamycin could be used to reduce abscess formation after severe lactational mastitis, therefore, avoids unnecessary operations and hospitalization.