Pharmaceutical Care of Necrotizing Fasciitis of the Left Breast in a Lactating Puerperal Woman: A Pharmacotherapy Workup-based Case Report

Abstract

Background: Necrotising fasciitis (NF) is an uncommon, fulminant infection of the superficial fascia and subcutaneous tissue that carries considerable morbidity and mortality when recognition or intervention is delayed. Primary involvement of the breast is exceptionally rare, and the small number of reported cases has arisen predominantly in the puerperium, a period during which the physiological demands of lactation compound diagnostic and therapeutic difficulty. Because puerperal breast NF simultaneously threatens maternal survival, continuation of breastfeeding, and psychological wellbeing, its management warrants a coordinated multidisciplinary approach in which the ward-based pharmacist assumes a role extending well beyond the supply of medicines. Case Presentation: A 19-year-old primiparous woman presented approximately four weeks postpartum with fever, followed by rapidly progressive swelling and severe pain of the left breast. Wound culture yielded heavy monomicrobial growth of Staphylococcus species, with susceptibility to ciprofloxacin and ampicillin, intermediate susceptibility to gentamicin, chloramphenicol and cefuroxime, and resistance to streptomycin, cefotaxime and ceftazidime. She underwent surgical debridement, with skin grafting and flap reconstruction planned for definitive closure. Pharmaceutical Care Intervention: Pharmaceutical care was structured using the Pharmacotherapy Workup framework of Cipolle et al. (2012), which assesses each prescribed medicine against four cornerstones—indication, effectiveness, safety, and adherence. Applying this framework, the surgical ward pharmacist conducted medication reconciliation, reviewed the empirical antimicrobial regimen against the culture and sensitivity report, appraised the safety of lactation-suppressing therapy, and identified non-adherence secondary to financial constraints as the principal drug therapy problem. Interventions included cost-saving substitution, facilitated access to subsidised medicines, structured counselling, and nutritional and psychosocial support. Outcome: The patient achieved satisfactory wound granulation, adequate analgesia, resolution of fever, and no progression to sepsis, with improved adherence and reduced out-of-pocket expenditure associated with the pharmacist-led intervention. Conclusion: The deliberate integration of a dedicated pharmacist into the surgical multidisciplinary team was associated with clinical, humanistic and economic benefits in this case of puerperal breast necrotising fasciitis, illustrating the potential value of embedded surgical ward pharmacy services in resource-constrained settings.