Points in history

  • Are they lactating?
  • Are they a smoker?
  • Is there a pre-existing, long-standing skin lesion?
Admission is required if:
  • There are signs of sepsis - (tachycardia, fever chills)
  • The infection progresses rapidly
  • The woman is haemodynamically unstable or immunocompromised

Lactating women

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.

Central (peri-ductal) infection

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

 

Infection of skin lesion

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

Hidradenitis suppurativa results in multiple, recurrent, troublesome small skin abscesses beneath the breasts, in the axilla and in the groin. Surgical intervention is generally not recommended.

Palpable abnormality of breast tissue

Refer as breast lump pathway.

Recurrent infections or not settled with antibiotics

Refer urgent suspicion of cancer

  • Mastitis or breast inflammation which does not settle or recurs after one course of antibiotics

Editorial Information

Last reviewed: 23/11/2022

Next review date: 23/11/2024

Version: 2022

Reviewer name(s): Maria Bews-Hair.