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==Overview==
==Overview==
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.
==Medical Therapy==
==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 breastsThe 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===
* 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]] containedFor 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.
 
===Non-puerperal Mastitis===
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.<ref name="pmid8188014">{{cite journal| author=Pahnke VG, Goepel E| title=[Non-puerperal mastitis: a disease without end? (Results of a long-term study)]. | journal=Geburtshilfe Frauenheilkd | year= 1994 | volume= 54 | issue= 3 | pages= 155-60 | pmid=8188014 | doi=10.1055/s-2007-1023572 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8188014  }} </ref><ref name="pmid2040409">{{cite journal| author=Goepel E, Pahnke VG| title=[Successful therapy of nonpuerperal mastitis--already routine or still a rarity?]. | journal=Geburtshilfe Frauenheilkd | year= 1991 | volume= 51 | issue= 2 | pages= 109-16 | pmid=2040409 | doi=10.1055/s-2007-1023685 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2040409  }} </ref>


In severe cases it may be required to stop [[lactation]] and use lactation inhibiting medication.
*[[Antibiotics]] should be given in addition to [[prolactin]] inhibiting medication if there are clear signs of [[infection]].


'''Nonpuerperal mastitis'''
*[[Granulomatous]] mastitis has been treated with some success by a combination of [[steroid]]s and [[prolactin]] inhibiting medication.


Treatment according to presumed cause, diagnosis and treatment of underlying condition is very important.
*More exotic treatments for non-puerperal mastitis that have been mentioned to show at least some efficacy include local and systemic [[progestins]] or [[progesterone]] <ref name="pmid8188014">{{cite journal| author=Pahnke VG, Goepel E| title=[Non-puerperal mastitis: a disease without end? (Results of a long-term study)]. | journal=Geburtshilfe Frauenheilkd | year= 1994 | volume= 54 | issue= 3 | pages= 155-60 | pmid=8188014 | doi=10.1055/s-2007-1023572 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8188014  }} </ref><ref name="pmid2040409">{{cite journal| author=Goepel E, Pahnke VG| title=[Successful therapy of nonpuerperal mastitis--already routine or still a rarity?]. | journal=Geburtshilfe Frauenheilkd | year= 1991 | volume= 51 | issue= 2 | pages= 109-16 | pmid=2040409 | doi=10.1055/s-2007-1023685 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2040409  }} </ref>, and [[Danazol]].


[[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).
*[[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


[[Antibiotics]] should be given in addition to prolactin inhibiting medication if there are clear signs of infection.
*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.
*Approximately 30% of cases develop chronic or recurring mastitis requiring long term or indefinite treatment with [[prolactin]] inhibiting medication.<ref name="pmid8188014">{{cite journal| author=Pahnke VG, Goepel E| title=[Non-puerperal mastitis: a disease without end? (Results of a long-term study)]. | journal=Geburtshilfe Frauenheilkd | year= 1994 | volume= 54 | issue= 3 | pages= 155-60 | pmid=8188014 | doi=10.1055/s-2007-1023572 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8188014  }} </ref><ref name="pmid2040409">{{cite journal| author=Goepel E, Pahnke VG| title=[Successful therapy of nonpuerperal mastitis--already routine or still a rarity?]. | journal=Geburtshilfe Frauenheilkd | year= 1991 | volume= 51 | issue= 2 | pages= 109-16 | pmid=2040409 | doi=10.1055/s-2007-1023685 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2040409  }} </ref>


[[Granulomatous]] mastitis has been treated with some success by a combination of [[steroid]]s and Prolactin inhibiting medication (Krause et al 1994).
===Granulomatous mastitis===


More exotic treatments for nonpuerperal mastitis that have been mentioned to show at least some efficacy include local and systemic Progestins or Progesteron (Goepel & Pahnke 1991), antidiuretics, Vitex Agnus Castus extract and Danazol.
*[[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>


NSAIDs are being used to treat symptoms of the [[inflammation]], however it must be considered that these medicaments also affect [[pituitary]] function and tend to increase Prolactin and [[IGF-1]] levels (Caviezel et al 1983).
*[[Methotrexate]] 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>


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).
===Antimicrobial regimen===


Approximately 30% of cases develop chronic or recurring mastitis requiring long term or indefinite treatment with Prolactin inhibiting medication (Goerke et al 2003).
*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 (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==
==References==
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Latest revision as of 22:38, 29 July 2020

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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, 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.

Medical Therapy

Puerperal Mastitis

  • 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.

Non-puerperal Mastitis

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]
  • 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.
  • 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]

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.[3][4]

Antimicrobial regimen

References

  1. 1.0 1.1 1.2 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.
  2. 2.0 2.1 2.2 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.
  3. 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.
  4. 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.
  5. Peña-Santos G, Ruiz-Moreno JL (2011). "[Idiopathic granulomatous mastitis treated with steroids and methotrexate]". Ginecol Obstet Mex. 79 (6): 373–6. PMID 21966829.
  6. 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.

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