Treatments for breast abscesses in breastfeeding women

There is insufficient evidence on the effect of needle aspiration for breast abscesses in breastfeeding women compared with incision and drainage. Treatment failure might be more common with needle aspiration comapred with incision and drainage

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, blinding, selective reporting, and loss to follow/up), by inconsistency (unexplained variability in results), and by imprecise results (few patients and outcome events).

Summary

A Cochrane review included 4 studies with a total of 325 subjects. Mean time (days) to complete resolution of breast abscess (3 studies) favoured needle aspiration (with and without ultrasound guidance) over incision and drainage (I&D). However, there was substantial heterogeneity among these data (I²=97%) and two studies excluded women who had treatment failure, and the third study the number of women who were lost to follow-up for either group was not reported. Continuation of breastfeeding, after treatment (success): results favoured the needle aspiration group, the data were not pooled because of substantial unexplained heterogeneity (I2 = 97%). Treatment failure was more common among women treated with needle aspiration compared to those who underwent I&D (RR 16.12; 95% CI 2.21 to 117.73; two studies, n = 115, low quality evidence). All abscesses in the I&D group were successfully treated. No data were reported for adverse events.

Incision and drainage (I&D) with or without antibiotics: In one study (150 women) comparing the value of adding a broad-spectrum cephalosporin (single dose or a course of treatment) to women who underwent I&D for breast abscesses, the mean time to resolution of breast abscess was reported as being similar in all groups (although women with infection were excluded). Mean time to resolution for women who received a course of antibiotics was reported as 7.3 days, 6.9 days for women who received a single dose of antibiotics and 7.4 days for women who did not receive antibiotics. For treatment failure, there was no clear difference between the groups of women who received antibiotics (either a single dose or a course of antibiotics) and those who did not (RR 1.00; 95% CI 0.36 to 2.76). Included studies rarely reported adverse events. For post-operative complications/morbidity, there was no difference in the risk of wound infections between the antibiotics and no antibiotics groups (RR 0.58; 95% CI 0.29 to 1.17), irrespective of whether women received a single dose or a course of antibiotics.

Clinical comments

Date of latest search: 27 February 2015

Ədəbiyyat

1. Irusen H, Rohwer AC, Steyn DW et al. Treatments for breast abscesses in breastfeeding women. Cochrane Database Syst Rev 2015;(8):CD010490.