Breast infection

For mastitis in lactating women start:

• Flucloxacillin 500mg QDS for 10-14 days
• Erythromycin 250-500mg QDS for 10-14 days if penicillin allergic
• Clarithromycin 500mg BD for 10-14 days is an alternative

Encourage continued breast feeding, including from the affected breast. If this is too painful, encourage use of breast pump to maintain breastfeeding.

Lactating breast abscesses can quickly destroy breast tissue and urgent referral is required by phoning on-call breast surgeon if abscess is present or not settling rapidly.

Peri-ductal mastitis results in persistent and troublesome inflammation of the periareolar area, especially in smokers.

Treat with:

• Co-amoxiclav 500/125mg TDS for 10-14 days
• Erythromycin 250-500mg QDS plus Metronidazole 500mg TDSfor 10-14 days if penicillin allergic
• Or Clarithromycin 500mg BD plus Metronidazole 500mg TDS for 10-14 days

Sebaceous/epidermoid cysts do not require referral even if acutely inflamed (try Co-amoxiclav). If troublesome, persistent cyst or recurrent infections in same cyst consider routine referral for excision.

Treat with:

• Co-amoxiclav 500/125mg TDS for 10-14 days
• Erythromycin 250-500mg QDS plus Metronidazole 500mg TDS for 10-14 days if penicillin allergic
• Or Clarithromycin 500mg BD plus Metronidazole 500mg TDS for 10-14 days

Refer as breast lump pathway.