# Acute lactational mastitis - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Antimicrobial 2023 · ABM Clinical Protocol #36: Mastitis Spectrum 2022 · Egyptian National Drug Formulary, antimicrobial 2023, cephalexin monograph (printed p. 211) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023 - Egyptian National Drug Formulary, antimicrobial 2023, cephalexin monograph (printed p. 211) - Acute Mastitis - disease-level clinical article (mastitis-full.txt) ## Treatment metadata - Amoxicillin + Clavulanic acid — 1000 mg — oral.solid - Referral & safety-netting (no drug therapy) - Cefalexin — 500 mg — oral.solid - Clindamycin — 300 mg — oral.solid ## Complete treatment card ```text ACUTE LACTATIONAL MASTITIS Sources: Egyptian National Drug Formulary - Antimicrobial 2023 · ABM Clinical Protocol #36: Mastitis Spectrum 2022 · Egyptian National Drug Formulary, antimicrobial 2023, cephalexin monograph (printed p. 211) Review status: REVIEWED against Egyptian National Drug Formulary - Antimicrobial 2023, Egyptian National Drug Formulary, antimicrobial 2023, cephalexin monograph (printed p. 211), Acute Mastitis - disease-level clinical article (mastitis-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - A firm, red, swollen, painful area of one breast develops, often after engorgement or a blocked duct - Fever of 38C (100.4F) or higher, with rapid pulse, chills, muscle aches, and malaise [chills · fever · malaise · muscle pain · tachycardia] - Nipple inversion and thick nipple discharge can occur with periductal mastitis [nipple discharge] - Idiopathic granulomatous mastitis can bring joint swelling, joint pain, and tender red nodules on the lower legs [joint pain · joint swelling · skin nodule] SIGNS - what you find (3) - In idiopathic granulomatous mastitis, the mass spares the area directly beneath the areola, unlike other quadrants - A breast mass over 5 cm with multiple fistulas and over 20 mL of daily discharge marks severe IGM [breast lump · fistula] - A breast mass under 2 cm with minimal pain and no fistula marks mild IGM [breast lump] TESTS (7) - Systemic symptoms lasting more than 24 hours should prompt clinical evaluation for mastitis - A milk culture is checked when symptoms have not improved after 48 hours of first-line antibiotics - Ultrasound of a breast abscess shows irregular pockets of pus-filled fluid - A milk duct wider than 3 mm with internal debris on ultrasound is typical of periductal mastitis - For nonlactational mastitis, MRI beats mammography and ultrasound on sensitivity, and inflamed areas show ring-like or patchy enhancement - Biopsy is the gold-standard test for nonlactational mastitis because IGM can mimic breast cancer clinically - On biopsy, IGM shows lobule-centered granulomatous inflammation that is necrotizing but lacks caseation IF NOT THIS - what else fits (5) - Inflammatory breast carcinoma is a differential across lactational and nonlactational mastitis - Breast abscess - Galactocele - Duct ectasia - Sarcoidosis is a differential for granulomatous mastitis Source StatPearls "Acute Mastitis" - disease-level clinical article Status traced to the source above 1. AMOXICILLIN + CLAVULANIC ACID [1st line] Adult 1 g (875/125 mg) orally twice daily x 5 to 7 days for mild to moderate infection and 10 days for severe infection Peds Not applicable in pediatric care Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Beta-lactam/beta-lactamase-inhibitor combination covering Staphylococcus aureus and streptococci, the usual pathogens of lactational mastitis; first-line antibiotic while breastfeeding continues. Caution Encourage continued breastfeeding or milk expression to prevent stasis. Refer for ultrasound if fluctuant mass (breast abscess) develops. Contraindicated in penicillin allergy. Egypt E-MOXCLAV 1G 10 F.C. TAB. EIPICO 14.00 EGP (1.40/unit) JULMENTIN 2X 1GM 15 TAB. JULPHAR 57.50 EGP (3.83/unit) DEXICLAVE 1 GM 10 F.C. TABS. RAMEDA > NOVE... 38.50 EGP (3.85/unit) MACLAVEX 1 GM 14 F.C.TABS. MASH PREMIERE 105.00 EGP (7.50/unit) CLAVIMOX 1 GM 12 F.C.TABS. PHARCO 130.00 EGP (10.83/unit) MEGAMOX 1 GM 14 F.C. TABS. AL JAZEERA PH... 178.00 EGP (12.71/unit) CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 106.00 EGP AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETS GLAXO SMITHKLINE 169.00 EGP LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Acute Mastitis - disease-level clinical article (mastitis-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Severe cases require IV antibiotics (empiric vancomycin) and hospitalization, rather than oral outpatient therapy. 3. CEFALEXIN [2nd line] Adult 500 mg orally 4 times daily Peds Not applicable in pediatric care Choice Clindamycin is the article's alternative, for severe penicillin allergy or resistant infection. Source Egyptian National Drug Formulary, antimicrobial 2023, cephalexin monograph (printed p. 211) Why First-generation cephalosporin covering the same staphylococcal and streptococcal pathogens as amoxicillin-clavulanate; the alternative for patients with a non-severe penicillin allergy. Caution Caution in severe renal impairment. Renal impairment is a number, not a feeling: at creatinine clearance 30-59 mL/min cap the total at 1 g a day; at 15-29 give 250 mg every 8-12 hours. Cefalexin is an alternative for non-severe penicillin allergy. Egypt CEFLODIX 500 MG 12 CAPS. ARAB CAPS > P... 9.00 EGP (0.75/unit) CEPHALEXCID 500 MG 12 CAPS. CID 10.30 EGP (0.86/unit) CEPHOXIN 500MG 12 TAB. PHARCO B 10.50 EGP (0.88/unit) CEPHALEXIN 500MG 10 CAPS. ARAB DRUG COM... 10.10 EGP (1.01/unit) MEDICEFLEXIN 500 MG 20 CAPS. T3A PHARMA > ... 25.25 EGP (1.26/unit) CEPHALEXIN 500MG 12 CAPS B.P.2007 SHIFA MEDICAL PRODUCTS > O... 27.00 EGP (2.25/unit) KEFLEX 500 MG 12 CAPS. HIKMA PHARMA 58.00 EGP (4.83/unit) CEPOREX 500MG 12 TABS. GLAXO SMITHKLINE 69.00 EGP (5.75/unit) AMTHROST 125MG/5ML SUSP. 60ML SIGMA > SABAA 4.00 EGP -> ? strength differs, ? different route - not oral solid AMTHROST 250MG/5ML SUSP. 60ML SIGMA > SABAA 4.50 EGP -> ? strength differs, ? different route - not oral solid 4. CLINDAMYCIN [2nd line] Adult Oral: 300–450 mg every 6 hours. x 10-14 days Peds 8-20 mg/kg/day (Children (oral, capsule): 8 to 20 mg/kg/day divided every 6 to 8 hours.) 3kg -> 24-60 mg/day 4kg -> 32-80 mg/day 5kg -> 40-100 mg/day 6kg -> 48-120 mg/day 7kg -> 56-140 mg/day 8kg -> 64-160 mg/day 9kg -> 72-180 mg/day 10kg -> 80-200 mg/day 11kg -> 88-220 mg/day 12kg -> 96-240 mg/day 13kg -> 104-260 mg/day 14kg -> 112-280 mg/day 15kg -> 120-300 mg/day 16kg -> 128-320 mg/day 17kg -> 136-340 mg/day 18kg -> 144-360 mg/day 19kg -> 152-380 mg/day 20kg -> 160-400 mg/day 21kg -> 168-420 mg/day 22kg -> 176-440 mg/day 23kg -> 184-460 mg/day 24kg -> 192-480 mg/day 25kg -> 200-500 mg/day 26kg -> 208-520 mg/day 27kg -> 216-540 mg/day 28kg -> 224-560 mg/day 29kg -> 232-580 mg/day 30kg -> 240-600 mg/day 31kg -> 248-620 mg/day 32kg -> 256-640 mg/day 33kg -> 264-660 mg/day 34kg -> 272-680 mg/day 35kg -> 280-700 mg/day 36kg -> 288-720 mg/day 37kg -> 296-740 mg/day 38kg -> 304-760 mg/day 39kg -> 312-780 mg/day 40kg -> 320-800 mg/day 41kg -> 328-820 mg/day 42kg -> 336-840 mg/day 43kg -> 344-860 mg/day 44kg -> 352-880 mg/day 45kg -> 360-900 mg/day 46kg -> 368-920 mg/day 47kg -> 376-940 mg/day 48kg -> 384-960 mg/day 49kg -> 392-980 mg/day 50kg -> 400-1000 mg/day Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Lincosamide antibiotic recommended for acute lactational mastitis in patients with severe penicillin allergy. Caution May cause Clostridioides difficile-associated diarrhea (CDAD) and pseudomembranous colitis; monitor bowel frequency. Clindamycin has potential to cause adverse effects on breastfed infant's GI flora; monitor infant for diarrhea. Egypt ADCOCLINDACE 300 MG 16 CAPS. ARAB DRUG COM... 24.00 EGP (1.50/unit) CLINACYN 300MG 16 CAPS. SIGMA > EGYPT... 31.50 EGP (1.97/unit) CLINDAM 300 MG 16 CAPS. SIGMA > OCTOB... 75.00 EGP (4.69/unit) MEPACLIND 300MG 8 CAPS. MEPACO 38.00 EGP (4.75/unit) CLINDACINE ART 300 MG 12 CAPS. RAMEDA > ART ... 76.00 EGP (6.33/unit) ALFACLINDAMYCIN 300 MG 10 CAPS. ATCO PHARMA >... 69.00 EGP (6.90/unit) DALACIN C 300MG 10 CAPS. PFIZER 114.00 EGP (11.40/unit) KLENDABIOTICAM 1 % TOP. SOLUTION PANAX PHARMA 8.50 EGP -> ? strength differs, ? different route - not oral solid ADCOCLINDACE 10MG/ML TOP. SOL. ARAB DRUG COM... 12.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)