Nursing mothers who develop breast abscesses or mastitis one to four weeks
postpartum should be considered as having penicillin-resistant
staphylococcal infections.  Drug treatment options in order of preference
are:
        1.  Penicillinase-Resistant Penicillins (methicillin, oxacillin,
nafcillin, cloxacillin, dicloxacillin)
        2.  Cephalosporins (cephalothin, cefazolin, cefalexin, cephradine,
cefamandole, cefoxitin, third-generation
cephalosporins)
        3.  Aminoglycosides (gentamtycin, vancomycin, lincomycin,
clindamycin)
        4.  Erythromycins (non-estolates)
        5.  Macrolides (azithromycin, clarithromycin, dithromycin)
        6.  Kanamycin
        7.  Bacitracin (do not breastfeed if this drug is necessary)
        8.  Chloramphenicol (do not breastfeed if this drug is necessary)
        9.  Sulmethoxazole/trimethoprim
        PLUS analgesic / antipyretic relief as needed

Frank J. Nice, DPA, CPHP

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