Mastitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]
Overview
Supportive care is the mainstay of therapy for puerperal mastitis. Supportive therapy includes massage, heat application, cold compresses and frequent breastfeeding. The treatment for non-puerperal mastitis is based on the underlying condition. Pharmacological therapies for non-puerperal 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 medications.
Medical Therapy
Puerperal 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.[2][3]
- 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.
- More exotic treatments for non-puerperal mastitis that have been mentioned to show at least some efficacy include local and systemic progestins or progesterone [2][3], 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
- 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.
- Approximately 30% of cases develop chronic or recurring mastitis requiring long term or indefinite treatment with prolactin inhibiting medication.[2][3]
Granulomatous mastitis
- Steroid is the treatment of choice with or without prolactin inhibiting medications although a gold standard treatment modality has not been well established.[4][5]
- Metothrexate and azathioprine can be added to maintain remission.[6]
Antimicrobial regimen
- Mastitis[7]
- 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.
- ↑ 2.0 2.1 2.2 Pahnke VG, Goepel E (1994). "[Non-puerperal mastitis: a disease without end? (Results of a long-term study)]". Geburtshilfe Frauenheilkd. 54 (3): 155–60. doi:10.1055/s-2007-1023572. PMID 8188014.
- ↑ 3.0 3.1 3.2 Goepel E, Pahnke VG (1991). "[Successful therapy of nonpuerperal mastitis--already routine or still a rarity?]". Geburtshilfe Frauenheilkd. 51 (2): 109–16. doi:10.1055/s-2007-1023685. PMID 2040409.
- ↑ Altintoprak F, Kivilcim T, Yalkin O, Uzunoglu Y, Kahyaoglu Z, Dilek ON (2015). "Topical Steroids Are Effective in the Treatment of Idiopathic Granulomatous Mastitis". World J Surg. 39 (11): 2718–23. doi:10.1007/s00268-015-3147-9. PMID 26148520.
- ↑ Zhang LN, Shi TY, Yang YJ, Zhang FC (2014). "An SLE patient with prolactinoma and recurrent granulomatous mastitis successfully treated with hydroxychloroquine and bromocriptine". Lupus. 23 (4): 417–20. doi:10.1177/0961203313520059. PMID 24446305.
- ↑ Peña-Santos G, Ruiz-Moreno JL (2011). "[Idiopathic granulomatous mastitis treated with steroids and methotrexate]". Ginecol Obstet Mex. 79 (6): 373–6. PMID 21966829.
- ↑ 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.