Doses of antimicrobial therapy for mastitis and breast abscess in children and adolescents*

Agent	Dose	Maximum daily dose
Oral agents
Cephalexin	25 to 50 mg/kg per day orally in three or four doses	2 g/day
Clindamycin^¶	30 to 40 mg/kg per day orally in three or four doses	1.8 g/day
Cloxacillin^Δ	25 to 50 mg/kg per day orally in four doses	2 g/day
Dicloxacillin	25 to 50 mg/kg per day orally in four doses	2 g/day
TMP-SMX^¶^◊	8 to 12 mg TMP component/kg per day orally in two doses	320 mg/day (TMP component)
Parenteral agents^§
Cefazolin^§	50 to 100 mg/kg per day IV in three doses	3 g/day (maximum of 6 g/day if severely ill appearing)
Clindamycin^¶	30 to 40 mg/kg per day IV in three or four doses	2.7 g/day
Nafcillin	100 to 200 mg/kg per day IV in four to six doses	12 g/day
Oxacillin	100 to 200 mg/kg per day IV in four to six doses	12 g/day
Vancomycin^¶^¥	Refer to UpToDate content related to alternative methods of dosing vancomycin for children older than 28 days

The doses in this table are intended for patients with normal renal function. The doses of many of these agents must be adjusted in the setting of renal insufficiency; refer to the Lexicomp drug-specific monographs for renal dose adjustments.

TMP-SMX: trimethoprim and sulfamethoxazole; IV: intravenously; MRSA: methicillin-resistant Staphylococcus aureus; AUC: area under the curve.

* Refer to UpToDate topic on mastitis and breast abscess in children and adolescents for additional information about the choice of regimen and duration of therapy.

¶ May be warranted in areas with incidence of community-associated MRSA greater than 10% of isolates or in patients with severe hypersensitivity to penicillins and cephalosporins.

Δ Not available in the United States.

◊ TMP-SMX is not active against group A Streptococcus.

§ Doses at the upper end of the ranges shown in this table are appropriate for patients with mastitis or breast abscess in association with severe systemic signs and symptoms.

¥ The approach to vancomycin dosing is generally determined at the institutional level. Refer to UpToDate content on invasive staphylococcal infections in children for details of trough-guided and AUC-guided vancomycin dosing.

Data from:

Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:147.
Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011; 52:e18.
American Academy of Pediatrics. Tables of antibacterial drug dosages. In: Red Book: 2021-2024 Report of the Committee on Infectious Diseases, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, Itasca, IL 2021. p.876.

Graphic 111071 Version 4.0

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Doses of antimicrobial therapy for mastitis and breast abscess in children and adolescents*