Dawaa Reference

infectious

Acute lactational mastitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 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 against3 documents
  • 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)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Acute Mastitis" - disease-level clinical article

Presentation findings are traced to the source above.

1

AMOXICILLIN + CLAVULANIC ACID

1st line

Strength1000 mg

Formoral.solid

Adult dose and duration

1 g (875/125 mg) orally twice daily x 5 to 7 days for mild to moderate infection and 10 days for severe infection

Paediatric dose

Not applicable in pediatric care

Dose 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.

Cautions
  • Encourage continued breastfeeding or milk expression to prevent stasis.
  • Refer for ultrasound if fluctuant mass (breast abscess) develops.
  • Contraindicated in penicillin allergy.
Egyptian brands
Egyptian brandManufacturerIndicative price
E-MOXCLAV 1G 10 F.C. TAB.EIPICO14.00 EGP (1.40/unit)
JULMENTIN 2X 1GM 15 TAB.JULPHAR57.50 EGP (3.83/unit)
DEXICLAVE 1 GM 10 F.C. TABS.RAMEDA > NOVELL PHARMA38.50 EGP (3.85/unit)
MACLAVEX 1 GM 14 F.C.TABS.MASH PREMIERE105.00 EGP (7.50/unit)
CLAVIMOX 1 GM 12 F.C.TABS.PHARCO130.00 EGP (10.83/unit)
MEGAMOX 1 GM 14 F.C. TABS.AL JAZEERA PHARMACEUTICAL > HIKMA PHARMA178.00 EGP (12.71/unit)
CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS.RAMEDA > ORGANOPHARMA106.00 EGP
AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETSGLAXO SMITHKLINE169.00 EGP
LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML? strength differs? different route - not oral solidMISR > AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.8.00 EGP
MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML? strength differs? different route - not oral solidCID8.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose 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.

Cautions
  • RED FLAG - Severe cases require IV antibiotics (empiric vancomycin) and hospitalization, rather than oral outpatient therapy.
3

CEFALEXIN

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg orally 4 times daily

Paediatric dose

Not applicable in pediatric care

Choice

Clindamycin is the article's alternative, for severe penicillin allergy or resistant infection.

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
CEFLODIX 500 MG 12 CAPS.ARAB CAPS > PHAROPHARMA9.00 EGP (0.75/unit)
CEPHALEXCID 500 MG 12 CAPS.CID10.30 EGP (0.86/unit)
CEPHOXIN 500MG 12 TAB.PHARCO B10.50 EGP (0.88/unit)
CEPHALEXIN 500MG 10 CAPS.ARAB DRUG COMPANY (ADCO)10.10 EGP (1.01/unit)
MEDICEFLEXIN 500 MG 20 CAPS.T3A PHARMA > RIVA PHARMA S.A.E.25.25 EGP (1.26/unit)
CEPHALEXIN 500MG 12 CAPS B.P.2007SHIFA MEDICAL PRODUCTS > OCTOBER PHARMA27.00 EGP (2.25/unit)
KEFLEX 500 MG 12 CAPS.HIKMA PHARMA58.00 EGP (4.83/unit)
CEPOREX 500MG 12 TABS.GLAXO SMITHKLINE69.00 EGP (5.75/unit)
AMTHROST 125MG/5ML SUSP. 60ML? strength differs? different route - not oral solidSIGMA > SABAA4.00 EGP
AMTHROST 250MG/5ML SUSP. 60ML? strength differs? different route - not oral solidSIGMA > SABAA4.50 EGP
4

CLINDAMYCIN

2nd line

Strength300 mg

Formoral.solid

Adult dose and duration

Oral: 300–450 mg every 6 hours. x 10-14 days

Paediatric dose

8-20 mg/kg/day

(Children (oral, capsule): 8 to 20 mg/kg/day divided every 6 to 8 hours.)

Dose by weight
3kg24-60 mg/day
4kg32-80 mg/day
5kg40-100 mg/day
6kg48-120 mg/day
7kg56-140 mg/day
8kg64-160 mg/day
9kg72-180 mg/day
10kg80-200 mg/day
11kg88-220 mg/day
12kg96-240 mg/day
13kg104-260 mg/day
14kg112-280 mg/day
15kg120-300 mg/day
16kg128-320 mg/day
17kg136-340 mg/day
18kg144-360 mg/day
19kg152-380 mg/day
20kg160-400 mg/day
21kg168-420 mg/day
22kg176-440 mg/day
23kg184-460 mg/day
24kg192-480 mg/day
25kg200-500 mg/day
26kg208-520 mg/day
27kg216-540 mg/day
28kg224-560 mg/day
29kg232-580 mg/day
30kg240-600 mg/day
31kg248-620 mg/day
32kg256-640 mg/day
33kg264-660 mg/day
34kg272-680 mg/day
35kg280-700 mg/day
36kg288-720 mg/day
37kg296-740 mg/day
38kg304-760 mg/day
39kg312-780 mg/day
40kg320-800 mg/day
41kg328-820 mg/day
42kg336-840 mg/day
43kg344-860 mg/day
44kg352-880 mg/day
45kg360-900 mg/day
46kg368-920 mg/day
47kg376-940 mg/day
48kg384-960 mg/day
49kg392-980 mg/day
50kg400-1000 mg/day
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023

Why

Lincosamide antibiotic recommended for acute lactational mastitis in patients with severe penicillin allergy.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
ADCOCLINDACE 300 MG 16 CAPS.ARAB DRUG COMPANY (ADCO)24.00 EGP (1.50/unit)
CLINACYN 300MG 16 CAPS.SIGMA > EGYPTIAN PHARMACISTS COMPANY31.50 EGP (1.97/unit)
CLINDAM 300 MG 16 CAPS.SIGMA > OCTOBER PHARMA75.00 EGP (4.69/unit)
MEPACLIND 300MG 8 CAPS.MEPACO38.00 EGP (4.75/unit)
CLINDACINE ART 300 MG 12 CAPS.RAMEDA > ART PHARMA76.00 EGP (6.33/unit)
ALFACLINDAMYCIN 300 MG 10 CAPS.ATCO PHARMA > ROTABIOGEN69.00 EGP (6.90/unit)
DALACIN C 300MG 10 CAPS.PFIZER114.00 EGP (11.40/unit)
KLENDABIOTICAM 1 % TOP. SOLUTION? strength differs? different route - not oral solidPANAX PHARMA8.50 EGP
ADCOCLINDACE 10MG/ML TOP. SOL.? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)12.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.