Mastitis medical therapy

Supportive care is the mainstay of therapy for puerperal mastitis. Supportive therapy includes massage, heat application, cold compresses, pain-relief 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.

• Supportive care is the mainstay of therapy for puerperal mastitis. Supportive therapy includes massage, heat application, cold compresses, pain-relief and frequent breastfeeding.

• 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.

• In severe cases it may be required to stop lactation and use lactation inhibiting medication.

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)

• Prolactin inhibiting medication has been shown to be most effective and reduce risk of recurrence.^[1][2]

• 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 ^[1][2], 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.^[1][2]

• Steroid is the treatment of choice with or without prolactin inhibiting medications although a gold standard treatment modality has not been well established.^[3][4]

• Methotrexate and azathioprine can be added to maintain remission.^[5]

• Mastitis^[6]

• 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

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