Mastitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Supportive care is the mainstay of therapy for peurperal mastitis. Supportive therapy includes massage, heat application, cold compresses and frequent breastfeeding. The treatment for non-peurperal mastitis is based on the underlying condition. Pharmacologic therapies for non-peurperal mastitis include Prolactin inhibiting agents, antimicrobial therapy, and nonsteroidal anti-inflammatory drugs (NSAIDS). Granulomatous mastitis has been treated with some success by a combination of steroids and Prolactin inhibiting medication (Krause et al 1994).
Medical Therapy
Peurperal Mastitis
Massage and the application of heat can help prior to feeding as this will aid the opening of the ducts and passageways. A cold compress may be used to ease the pain when not wanting to lose the milk, though it is most appropriate to reduce the levels of milk contained. For this reason it is also advised that the baby should frequently feed from the inflamed breast. However, the content of the milk may be slightly altered, sometimes being more salty, and the taste may make the baby reject the breast at the first instance.
The presence of cracks or sores on the nipples increases the likelihood of infection. Tight clothing or ill-fitting bras may also cause problems as they compress the breasts. The most common infecting organism is Staph. aureus, and babies carrying the organism in their noses are more likely to give it to their mothers;[1] the clinical significance of this finding is still unknown, but theoretically, removing carriage from the nursing infant's nose may help prevent recurrence.
In severe cases it may be required to stop lactation and use lactation inhibiting medication.
Non-puerperal Mastitis
Treatment according to presumed cause, diagnosis and treatment of underlying condition is very important.
Prolactin inhibiting medication has been shown to be most effective and reduce risk of recurrence (Goepel & Pahnke 1991, Krause et al 1994, Stauber & Weyerstrahl 2005, Petersen 2003, Goerke et al 2003).
Antibiotics should be given in addition to prolactin inhibiting medication if there are clear signs of infection.
Granulomatous mastitis has been treated with some success by a combination of steroids and Prolactin inhibiting medication (Krause et al 1994).
More exotic treatments for nonpuerperal mastitis that have been mentioned to show at least some efficacy include local and systemic Progestins or Progesterone (Goepel & Pahnke 1991), antidiuretics, Vitex Agnus Castus extract and Danazol.
NSAIDs are being used to treat symptoms of the inflammation, however it must be considered that these medications also affect pituitary function and tend to increase Prolactin and IGF-1 levels (Caviezel et al 1983).
Many variants of surgical procedures such as duct resection have been tried to reduce the risk of recurrent subareolar abscesses. So far the success rates are limited and conservative treatment seems preferable where possible (Petersen 2003, Hannavadi et al 2005).
Approximately 30% of cases develop chronic or recurring mastitis requiring long term or indefinite treatment with Prolactin inhibiting medication (Goerke et al 2003).
Antimicrobial regimen
- Mastitis[2]
- Preferred regimen (1): Amoxicillin-clavulanate 875 mg PO bid
- Preferred regimen (2): Cephalexin 500 mg PO qid
- Preferred regimen (3): Ciprofloxacin 500 mg PO bid
- Preferred regimen (4): Clindamycin 300 mg PO qid
- Preferred regimen (5): Dicloxacillin 500 mg PO qid
- Preferred regimen (6): Trimethoprim-sulfamethoxazole 160 mg/800 mg PO bid
References
- ↑ Amir LH, Garland SM, Lumley J. (2006). "A case-control study of mastitis: nasal carriage of Staphylococcus aureus". BMC Family Practice. 7: 57. doi:10.1186/1471-2296-7-57.
- ↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "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. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.