Most likely this is caused by Staphylococcus.  Probably they should cover her for MRSA with Clindamycin or Septa.  (if she were not too sick, ie. not in the hospital it would be acceptable to use Keflex or Augmentin for a couple of days and if no improvement in 2 or 3 days change to a drug that covers MRSA.

Occasionally mastitis occurs during pregnancy or adolescence.  Presumably some aspect of breast growth predisposes to mastitis.  The organisms would most likely be something that cause abcesses elsewhere in the skin, not organisms that cause respiratory bacterial infections.  Antibiotics that are first line for pulmnary infections are not first line for skin infecgitons.  Using an antibioitc that is inadequate for mastitis coverage like amoxicillin might induce antibioitc resistance.

Good lluck with this lady.  Let us know how she does.

Penny Soppas MD, IBCLC
Drexel Hill Pediatric Associates


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