Methods of treatment of mastitis in women: antibiotics, ointments, surgery

Treatment of mastitis is aimed at stopping the inflammatory process that develops in the tissues of the mammary gland due to a bacterial infection, and getting rid of its symptoms, in particular, swelling of the breast, pain, fever, etc.

Specific treatment methods for mastitis may vary depending on the stage of the disease, but the range of treatments available in medicine is quite limited.

Mastitis Treatment Methods

Today, for inflammation of the mammary glands, the following are used: conservative, that is, drug treatment of mastitis, physiotherapy, treatment of mastitis with folk remedies, and also - for purulent inflammation - surgical treatment of mastitis.

Since two types of mastitis are clearly classified, the main focus is on the treatment of lactational mastitis (other definitions: treatment of mastitis in a nursing mother, treatment of postpartum mastitis or puerperal).

However, the treatment of non-lactational mastitis – inflammation of the mammary glands that can develop when the breasts of women become infected outside the period of breast milk production after childbirth – is not sufficiently covered. Apparently, this is due to the fact that acute inflammation of the mammary gland usually occurs in lactating women: the number of patients with lactational mastitis is almost 87%. While only about 13% of cases are mastitis that occurs in non-lactating women – both in a mild superficial form and in the form of deep abscesses.

The basis of therapy is a combination of antibacterial drugs with the removal of purulent exudate either by aspiration or surgically - through a classic incision.

Ultrasound treatment of mastitis at the stage of serous inflammation or infiltrative inflammation can be carried out: as physiotherapists claim, thanks to the effect of ultrasound, local blood circulation and tissue metabolism are improved.

Mastitis in men is also treated using these methods. And to have an idea of what mastitis treatment in children should be, read the publications - Mammary glands in children and Mastitis in newborns

Drug treatment of mastitis

It should be noted that some do not differentiate between mastitis and lactostasis (milk stagnation in the breast). The fact is that it is with milk stagnation in the milk ducts and milk sinuses that the pathological process begins, often developing into postpartum mastitis - inflammation of the glandular tissue of the mammary gland. Moreover, lactostasis, which has almost identical symptoms, is sometimes called non-infectious mastitis, which adds to the confusion in terminology.

Speaking of confusion: treating catarrhal mastitis in women is problematic because, firstly, this type is not identified by most specialists, and, secondly, such a diagnosis only exists in veterinary medicine...

But let's return to lactostasis. When milk stasis occurs, it is necessary to continue feeding the baby and empty the sore breast, expressing milk, as is done when treating serous mastitis, which is the initial stage of inflammation - serous mastitis. At this stage, some doctors recommend treating mastitis with ointments: gentamicin, syntomycin, heparin, Levomekol, Sulfamekol, Baneocin, Traumeel S.

But the treatment of infiltrative mastitis - the next stage of mastitis in a nursing mother - includes measures to suppress milk production. For this, a drug such as Cabergoline (Dostinex) is used, which is taken twice a day at 0.25 mg (for two days). Or Bromocriptine tablets are prescribed (other trade names - Bromergon, Serocriptine, Parlodel, Pravidel) - one tablet (2.5 mg) twice a day (during meals, in the morning and in the evening).

Today, drug treatment of mastitis is etiological, since the main pathogens of the inflammatory process in the mammary glands are: Staphylococcus aureus, Streptococcus SPP, Klebsiella pneumonae, Haemophilus SPP, Peptococcus magnus, Entrobacter cloacae, Salmonella SPP. Therefore, the treatment of mastitis with antibiotics is caused by the need to suppress the bacterial infection.

Treatment of acute mastitis, that is, treatment of lactational mastitis in its acute form, will be most effective when using broad-spectrum antibacterial agents.

Mastitis can be treated with Amoxiclav (other trade names are Augmentin, Amoklavin, Klavocin) with the penicillin antibiotic amoxicillin and clavulanic acid (which makes it possible to suppress the resistance of Staphylococcus aureus); the method of administration is injection - intramuscular or intravenous drip (625-875 mg twice a day for a week). The aminoglycoside antibiotic Gentamicin sulfate is used - up to 240 mg per day (intravenously every 8 hours).

Also, for postpartum mastitis, cephalosporin antibiotics are prescribed: Cephalexin (Keflex, Flexin, Ospexin), Cefotaxime (Cefosin, Clafotaxime, Kefotex) or Cefuroxime (Ketocef, Cefuxime, Zinnat) - 400-500 mg up to three times a day.

For more information on which medications in this group can be used by nursing mothers, read the article – Antibiotics during breastfeeding

According to mammologist surgeons, treating mastitis without antibiotics – especially starting from the infiltrate stage – leads to the progression of the inflammatory process and the formation of a purulent focus in the tissues of the mammary gland.

Treatment of purulent mastitis

After the serous stage of inflammation and the formation of an infiltrate, the process moves to the stage of necrosis or suppuration. Treatment of purulent mastitis, which can be nodular, diffuse, phlegmonous, abscessing and gangrenous, requires not only antibacterial therapy.

In many cases, only treatment of mastitis by puncture gives a positive result, i.e. a puncture is made in the capsule filled with pus (if it is subcutaneous) and aspiration (suction) of the purulent contents is performed. Then an antibiotic solution with the addition of an anesthetic should be introduced into the freed cavity.

However, a puncture cannot be performed if the purulent focus is deep (intramammary) or if there is phlegmonous mastitis. Then surgical treatment of mastitis at the abscess stage is used: under general anesthesia, the skin and subcutaneous tissue are cut and, having reached the abscess, it is opened - with the removal of pus, excision of tissues affected by necrosis and washing with antiseptics. The wound is sutured and drainage is installed. The use of antibiotics after surgery for purulent mastitis continues, and its duration is determined by the attending physician - based on the results of a blood test and normalization of temperature indicators.

Treatment of non-lactation mastitis

Dilation or ectasia of the milk ducts of the mammary gland, complicated by a secondary bacterial infection, is an inflammatory condition of the milk ducts of the breast - periductal mastitis, which is typical for patients during menopause.

Treatment of non-lactational mastitis with ectasia of the milk ducts is carried out with antibiotics (orally and parenterally), NSAIDs (non-steroidal anti-inflammatory drugs), antihistamines. If conservative methods are ineffective, they resort to surgical intervention (with histological examination of the tissue sample for possible malignant nature of the pathology and long-term observation of patients).

Recurrent mammary gland abscesses are observed in focal idiopathic granulomatous mastitis, which is also called plasmacytic mastitis due to the infiltration of the gland stroma by plasma cells and epithelioid histiocytes. Clinically and radiologically, it can imitate breast cancer, and in such cases, chronic mastitis is treated surgically - by sectoral resection.

The same treatment methods are used for tuberculous mastitis accompanying pulmonary tuberculosis.

Treatment of fibrous mastitis – in the presence of an inflamed papillary node in the milk duct – is only surgical.

Inflammation of a mammary gland cyst, as well as lactocele and atheroma, can cause purulent mastitis. In such cases, treatment of cystic mastitis is no different from treatment of ordinary acute mastitis (except for the lack of need to suppress lactation).

The same rules apply when treatment of mastitis during pregnancy is necessary, but you need to consider which antibiotics can be used during pregnancy and which are contraindicated.

Treatment of mastitis with folk remedies

When someone recommends treating mastitis with folk remedies, in most cases they mean remedies that help eliminate milk stagnation in breastfeeding women. Because treating mastitis at home - when the inflammation site becomes purulent - is fraught with sepsis.

Thus, treating mastitis with cabbage leaves can reduce swelling and reduce local hyperthermia in lactostasis or the initial, serous stage of mastitis. But how does a woman know that the inflammatory process in her mammary gland has not gone further? In such a situation, applying cabbage leaves to the sore breast will only do harm, because it will take two or three days, during which the inflammation will intensify and lead to purulent mastitis.

Treatment of mastitis with camphor oil is possible only in case of milk stagnation, if a nursing woman has an excess of it, since camphor in the form of a compress reduces milk production.

The recommended treatment of mastitis with sea buckthorn (meaning sea buckthorn oil), as well as the treatment of mastitis with honey, grated beets, rye dough, aloe, apple cider vinegar, etc., which are used externally, will not affect the causative agents of inflammation that develops in the parenchyma of the mammary gland.

You shouldn't rely on the effect of warming compresses either, because thermal procedures are absolutely contraindicated in inflammatory processes. But in case of milk stagnation (when there is severe engorgement of the gland), you can use not only a light massage (including a warm shower), but also alternating hot and cold compresses: a hot compress (for seven to eight minutes) helps improve blood circulation and cleanse the milk ducts, and a cold compress (for three minutes) helps reduce swelling and relieve pain. But experts emphasize that this is not done in case of mastitis, but in cases of milk stagnation during lactation!