Breast Abscesses and Masses Medication

Updated: Apr 13, 2017
  • Author: Andrew C Miller, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Medication

Medication Summary

The goal of therapy is to eradicate the infection and minimize complications.

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Antibiotics

Class Summary

Antibacterial therapy must cover all likely pathogens in the context of the clinical setting.

Nafcillin

DOC for puerperal breast abscess. Treats infections caused by penicillinase-producing staphylococci. Used to initiate therapy when a penicillin G–resistant staphylococcal infection is suspected.

Because of occasional occurrence of thrombophlebitis associated with parenteral route (particularly in elderly persons), administer parenterally only for a short term (24-48 h) and change to PO if clinically possible.

Ampicillin-sulbactam sodium (Unasyn)

Alternative DOC for nonpuerperal breast abscess. Drug combination that utilizes a beta-lactamase inhibitor with ampicillin. Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.

Dicloxacillin

DOC for mastitis. Bactericidal antibiotic that inhibits cell wall synthesis. Used to treat infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when a staphylococcal infection is suspected.

Oxacillin (Bactocill)

Bactericidal antibiotic that inhibits cell wall synthesis. Used in the treatment of infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when a staphylococcal infection is suspected.

Amoxicillin/clavulanate (Augmentin, Augmentin ES-600, Augmentin XR)

Amoxicillin binds to penicillin-binding proteins, thus inhibiting final transpeptidation step of peptidoglycan synthesis in bacterial cell walls; addition of clavulanate inhibits beta-lactamase-producing bacteria, allowing amoxicillin extended spectrum of action

It is a semisynthetic antibiotic with a broad spectrum of bactericidal activity, covering both gram-negative and gram-positive microorganisms.

Doxycycline (Acticlate, Adoxa, Atridox)

Doxycycline is a tetracycline. Inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria; may block dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Tetracyclines are unsafe in pregnancy and secreted in breast milk. Not for use if patient is pregnant or breastfeeding.

 

Trimethoprim/sulfamethoxazole (Bactrim DS, Bactrim, Sulfatrim Pediatric)

Trimethoprim: Inhibits dihydrofolate reductase, thereby blocking production of tetrahydrofolic acid from dihydrofolic acid.

Sulfamethoxazole: Inhibits bacterial synthesis of dihydrofolic acid by competing with para-aminobenzoic acid. 

Clarithromycin (Biaxin, Biaxin XL)

Semisynthetic macrolide antibiotic that reversibly binds to P site of 50S ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein synthesis by stimulating dissociation of peptidyl t-RNA from ribosomes, thereby inhibiting bacterial growth

Clindamycin (Cleocin)

DOC for nonpuerperal breast abscess. An alternate DOC for patients with mastitis who are penicillin allergic and for those with suspected MRSA infection.

A lincosamide useful as treatment against serious skin and soft tissue infections caused by most staphylococcal strains. Also effective against aerobic and anaerobic streptococci, except enterococci.

Inhibits bacterial protein synthesis by inhibiting peptide chain initiation at the bacterial ribosome where it preferentially binds to the 50S ribosomal subunit, causing bacterial growth inhibition.

Vancomycin (Vancocin)

DOC for patients with puerperal breast abscess who are penicillin allergic, as well as those with suspected MRSA infection. It is a potent antibiotic directed against gram-positive organisms and active against enterococcal species. Useful in treatment of septicemia and skin structure infections. Indicated for patients who cannot receive, or have failed to respond to, penicillins and cephalosporins or who have infections with resistant staphylococci.

To avoid toxicity, current recommendation is to assay vancomycin trough levels after the third dose drawn 0.5 h before next dosing. Use CrCl to adjust dose in renal impairment, prn.

Dalbavancin (Dalvance)

Lipoglycopeptide antibiotic; interferes with cell wall synthesis by binding to D-alanyl-D-alanine terminus of the stem pentapeptide in nascent cell wall peptidoglycan, thus preventing cross-linking.

Bactericidal in vitro against Staphylococcus aureus and Streptococcus pyogenes at concentrations observed in humans at recommended doses.

The long half-life of dalbavancin should be considered before using in pregnancy.

Linezolid (Zyvox)

Binds to bacterial 23S rRNA of the 50S subunit to prevent protein translation; also elicits nonselective MAO inhibition

Information on use during pregnancy is limited. In breast feeding, the manufacturer advises caution.

Tigecycline (Tygacil)

A glycylcycline antibiotic that is structurally similar to tetracycline antibiotics; inhibits bacterial protein translation by binding to 30S ribosomal subunit, and blocks entry of amino-acyl tRNA molecules in ribosome A site.

Unsafe in pregnancy. In breastfeeding patients, use caution.

Daptomycin (Cubicin)

Cyclic lipopeptide: Binds to bacterial membranes and causes rapid depolarization of membrane potential; causes inhibition of protein, DNA, RNA synthesis, and bacterial cell death.

Successful use during second and third trimesters of pregnancy reported but limited information available. Use caution if breastfeeding.

Ceftaroline (Teflaro)

Beta-lactam cephalosporin with activity against aerobic and anaerobic gram-positive and aerobic gram-negative bacteria

Demonstrates activity in vivo against resistant methicillin-resistant Staphylococcus aureus (MRSA) strains and in vitro against vancomycin-resistant and linezolid-resistant S aureus.

Effects in pregnancy unknown. Use caution in breastfeeding.

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