MASTITIS

Question 1

Approach to the Critically Ill Mastitis

Answer 1

intravenous fluids at 30 mL/kg intravenous fluids and reassess volume status.

Vasopressors:
Norepinephrine continuous infusion at a rate of 0.01-0.3 μg/kg/minute; titrate by 0.02 μg/kg/minute every 5 minutes

Vasopressin continuous infusion of 0.01-0.04 units/minute

Vancomycin loading dose of 25-30 mg/kg intravenous followed by 15-20 mg/kg intravenous every 8-12 hours

Consult obstetrics

Question 2

Critical DDx

Answer 2

Mastitis

Necrotizing cellulitis

Abscess

Inflammatory breast cancer

Question 3

History & Physical

Answer 3

Post partum female
Breastfeeding
Nipple trauma and milk stasis

Acute onset:
Breast erythema, inflammation, edema

Flu like symptoms

Wedge shaped breast erythema

Question 4

Most common etiology

Answer 4

Staph Aureus (MC)

Strep
E. Coli

Question 5

Investigations

Answer 5

CBC

CRP

+/- ultrasound - r/o abscess

Question 6

Management: Stable patient

Answer 6

Continue breast feeding

NSAIDS

Warm / cold compresses

Dicloxacillin 500 mg by mouth every 6 hours
10 days

Amoxicillin-clavulanate 875 mg by mouth every 12 hours
10 days

Cephalexin 500 mg by mouth every 6 hours
10 days

MRSA:
Clindamycin 300 mg by mouth every 6 to 8
hours
10 days

Trimethoprim/sulfamethoxazole 160 mg/800 mg by mouth every 12 hours
10 days
C/I in infants are premature, <2 months of age, or are neonates with jaundice

Question 7

Management: Unstable

Answer 7

Clindamycin 600-900 mg intravenous every 8 hours

Vancomycin 20-35 mg/kg/dose intravenous as a loading dose (maximum dose 3,000 mg) followed by 10-15 mg/kg intravenous every 8 to 12 hours.

Question 8

Management: Fungal Infection

Answer 8

Patient:
Fluconazole loading dose of 400 mg by mouth on day 1, followed by 200 mg every 24 hours for a minimum of 14 days
Infant:
Loading dose of 6-12 mg/kg by mouth on day 1, followed by a dose of 3-6 mg/kg by mouth every 24 hours for a minimum of 14 days