Breastfeeding woman presenting with localised inflammatory features of the breast — pain, erythema, heat, and swelling — in the setting of a penicillin allergy. A first-line oral management course has already been completed but the inflammation has not settled.
The first-line regimen for penicillin-allergic patients — including analgesics, hot and cold packs, regular complete breast drainage with continued breastfeeding, and an oral antibiotic appropriate for penicillin-allergic patients (cephalexin or clindamycin) — did not achieve the goal of breast inflammation settling within 24–48 hours.
When first-line oral management has not controlled the inflammation, escalation to a more intensive level of care is the indicated next step. The full protocol specifies the criteria that guide this decision and the complete treatment approach for this situation.