A 35-year-old G3P3 presents to your office 3 weeks after an uncomplicated vaginal delivery. She has been successfully breastfeeding. She reports chills and a fever up to 38.3°C (101°F) at home. She states that she feels like she has flu, but has not had any sick contacts. She has no medical problems, prior surgeries, or allergies to medications. On examination, she has a temperature of 38°C (100.4°F) and generally appears in no distress. Head, ear, throat, lung, cardiac, abdominal, and pelvic examinations are all normal. A triangular area of erythema and tenderness is noted in the upper outer quadrant of the left breast. No masses or axillary lymphadenopathy are noted.
Which of the following is the best option for treatment of this patient?
A. Admission to the hospital for intravenous antibioticsPuerperal mastitis may be subacute, but is often characterized by chills, fever, and breast tenderness. If undiagnosed, it may progress to suppurative mastitis with abscess formation that requires drainage. The most common causative organism is Staphylococcus aureus, which is probably transmitted from the infant’s nose and throat. Initial antibiotic therapy should be directed at this organism, and should consist of either dicloxacillin 500 mg orally four times a day, or cephalexin 500 mg orally four times a day, for a total of 10 to 14 days. In penicillin-allergic patients, clindamycin 300 mg orally three times a day is recommended. If a mass is palpable, an abscess should be suspected. Incision and drainage is recommended for a breast abscess. Milk production should not be suppressed, and the patient should continue to breastfeed or pump on the affected breast. Symptomatic relief with ibuprofen and ice packs may also be of benefit.