Mastitis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Supportive care is the mainstay of therapy for | |||
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== | ==Medical Therapy== | ||
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 ''[[Staphylococcus aureus|Staph. aureus]]'', and babies carrying the organism in their noses are more likely to give it to their mothers;<ref>{{cite journal | title=A case-control study of mastitis: nasal carriage of ''Staphylococcus aureus'' | author=Amir LH, Garland SM, Lumley J. | journal=BMC Family Practice. | year=2006 | volume=7 | pages=57 | doi=10.1186/1471-2296-7-57 }}</ref> the clinical significance of this finding is still unknown, but theoretically, removing carriage from the nursing infant's nose may help prevent recurrence. | ===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 ''[[Staphylococcus aureus|Staph. aureus]]'', and babies carrying the organism in their noses are more likely to give it to their mothers;<ref>{{cite journal | title=A case-control study of mastitis: nasal carriage of ''Staphylococcus aureus'' | author=Amir LH, Garland SM, Lumley J. | journal=BMC Family Practice. | year=2006 | volume=7 | pages=57 | doi=10.1186/1471-2296-7-57}}</ref> 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. | In severe cases it may be required to stop [[lactation]] and use lactation inhibiting medication. | ||
===Non-puerperal Mastitis=== | ===Non-puerperal Mastitis=== | ||
Treatment according to presumed cause, diagnosis and treatment of underlying condition is very important. | 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). | [[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. | [[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 [[steroid]]s and | [[Granulomatous]] mastitis has been treated with some success by a combination of [[steroid]]s and [[prolactin]] inhibiting medication. | ||
More exotic treatments for | More exotic treatments for non-puerperal 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 | [[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 [[abscess]]es. So far the success rates are limited and conservative treatment seems preferable where possible (Petersen 2003, Hannavadi et al 2005). | Many variants of surgical procedures such as duct resection have been tried to reduce the risk of recurrent subareolar [[abscess]]es. 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 | Approximately 30% of cases develop chronic or recurring mastitis requiring long term or indefinite treatment with [[prolactin]] inhibiting medication (Goerke et al 2003). | ||
===Granulomatous mastitis=== | ===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.<ref name="pmid26148520">{{cite journal| author=Altintoprak F, Kivilcim T, Yalkin O, Uzunoglu Y, Kahyaoglu Z, Dilek ON| title=Topical Steroids Are Effective in the Treatment of Idiopathic Granulomatous Mastitis. | journal=World J Surg | year= 2015 | volume= 39 | issue= 11 | pages= 2718-23 | pmid=26148520 | doi=10.1007/s00268-015-3147-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26148520}}</ref><ref name="pmid24446305">{{cite journal| author=Zhang LN, Shi TY, Yang YJ, Zhang FC| title=An SLE patient with prolactinoma and recurrent granulomatous mastitis successfully treated with hydroxychloroquine and bromocriptine. | journal=Lupus | year= 2014 | volume= 23 | issue= 4 | pages= 417-20 | pmid=24446305 | doi=10.1177/0961203313520059 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24446305}}</ref> | |||
Metothrexate and azathioprine can be added to maintain remission.<ref name="pmid21966829">{{cite journal| author=Peña-Santos G, Ruiz-Moreno JL| title=[Idiopathic granulomatous mastitis treated with steroids and methotrexate]. | journal=Ginecol Obstet Mex | year= 2011 | volume= 79 | issue= 6 | pages= 373-6 | pmid=21966829 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21966829}}</ref> | |||
===Antimicrobial regimen=== | ===Antimicrobial regimen=== | ||
*Mastitis<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530 | |||
*Mastitis<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530}}</ref> | |||
:* Preferred regimen (1): [[Amoxicillin-clavulanate]] 875 mg PO bid | :* Preferred regimen (1): [[Amoxicillin-clavulanate]] 875 mg PO bid | ||
:* Preferred regimen (2): [[Cephalexin]] 500 mg PO qid | :* Preferred regimen (2): [[Cephalexin]] 500 mg PO qid | ||
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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 (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.
More exotic treatments for non-puerperal 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).
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.[2][3]
Metothrexate and azathioprine can be added to maintain remission.[4]
Antimicrobial regimen
- Mastitis[5]
- 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.
- ↑ 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.