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

The treatment of mastitis is aimed at stopping the inflammatory process that develops in the tissues of the mammary gland due to bacterial infection, and getting rid of its symptoms, in particular, swelling of the chest, pain, febrile state, etc.

The specific methods of treatment of mastitis may vary depending on the stage of the disease, but in the arsenal of medicine their spectrum is rather limited.

Methods of treatment of mastitis

To date, with inflammation of the mammary glands used: conservative, that is, drug treatment of mastitis, physiotherapy, treatment of mastitis with alternative means, and - with purulent inflammation - surgical treatment of mastitis.

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

But the treatment of non-lactative mastitis - inflammation of the mammary glands, which can develop with breast infection in women outside the period of producing breast milk after the birth of a child - is not sufficiently covered. Obviously, this is due to the fact that acute inflammation of the breast usually occurs in nursing women: the number of patients with lactation mastitis is almost 87%. Whereas only about 13% of cases occur in mastitis that occurs in non-breastfed women - both in light superficial form and in the form of deep abscesses.

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

May be treated with ultrasound of mastitis at the stage of serous inflammation or infiltrative: according to physiotherapists, due to the influence of ultrasound, local blood circulation and tissue metabolism improve.

These methods are used to treat mastitis in men. And in order to have an idea of what should be the treatment of mastitis in children, read the publication - Breasts in Children and Mastitis in Newborns

Medical treatment of mastitis

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

By the way, about the confusion: the treatment of catarrhal mastitis in women is problematic, because, firstly, this kind is not distinguished by the majority of specialists, and, secondly, such a diagnosis exists only in veterinary medicine ...  

But back to lactostasis. When milk is stagnant, it is necessary to continue feeding the baby and empty the sick chest, decanting the milk, as is done when serous mastitis is treated, which is the initial stage of inflammation - serous mastitis. At this stage, some doctors recommend the treatment of mastitis with ointments: gentamicin, sintomycin, heparin, Levomecol, Sulfamecol, Baneoocin, Traumele C.

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

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

Treatment of acute mastitis, that is, treatment of lactational mastitis in acute form will be most effective when using antibacterial agents of a wide spectrum of action.

It is possible to treat mastitis with Amoxiclavum (other trade names - Augmentin, Amoclavine, Klavocin) with penicillin antibiotic amoxicillin and clavulanic acid (which makes it possible to suppress the resistance of Staphylococcus aureus); a method of injecting - an injection into the muscle or a drop in the vein (625-875 mg twice a day for a week). The antibiotic-aminoglycoside is used Gentamycin sulfate - per day up to 240 mg (per vein every 8 hours).

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

More details about what medicines of this group can be used for breastfeeding, read in the article - Antibiotics for breastfeeding

According to surgeons-mammologists, the treatment of mastitis without antibiotics - especially since the infiltration stage - leads to the progression of the inflammatory process and the formation of a purulent focus in the tissues of the breast.

Treatment of purulent mastitis

After the serous stage of inflammation and the formation of the infiltrate, the process passes to the stage of necrosis or suppuration. Treatment of purulent mastitis, which can be nodular, diffuse, abscessy, abscessed and gangrenous, requires not only antibiotic therapy.

In many cases, only mastitis treatment with puncture gives a positive result, that is, a puncture of the pus-filled capsule (with its subcutaneous localization) is made and aspiration (suction) of the purulent contents is performed. Then a solution of an antibiotic with the addition of an anesthetic should be introduced into the released cavity.

However, the puncture can not be done with a deep (intramammary) occurrence of a purulent focus or phlegmonous mastitis. And then the surgical treatment of mastitis at the abscess stage is applied: under general anesthesia, the skin and subcutaneous tissue are dissected and, after reaching the abscess, it is opened with the removal of pus, excision of tissue affected by necrosis and washing with antiseptics. The wound is sutured and drainage is established. The use of antibiotics after surgery for purulent mastitis continues, and its duration is determined by the attending physician - according to the results of a blood test and the normalization of temperature indicators.

Treatment of non-lactational mastitis

Expansion or ectasia of the ducts of the breast, complicated by a secondary bacterial infection, is an inflammatory condition of the milk ducts of the breast - periductal (near-flow) mastitis, which is typical for patients during menopause.

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

Recurrent mammary abscesses are noted in focal idiopathic granulomatous mastitis, which is also called plasmacytic mastitis due to infiltration of the stroma of the gland with plasmocytes and epithelioid histiocytes. Clinically and radiologically, he can simulate breast cancer, and in such cases, the treatment of chronic mastitis is performed surgically - by sectoral resection.

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

Treatment of fibrotic mastitis - if there is an inflamed papillary node in the milk duct - only operative.

Inflammation of the breast cyst, as well as lactocele and atheroma can cause purulent mastitis. In such cases, the treatment of cystic mastitis does not differ from the treatment of ordinary acute mastitis (with the exception of the absence of the need to suppress lactation).

The same rules apply when it is necessary to treat mastitis during pregnancy, only you need to consider which antibiotics can be used during pregnancy and which ones are contraindicated.

Treatment of mastitis by alternative means

When someone recommends the treatment of mastitis by alternative means, in most cases, means means to help eliminate stagnant milk in breastfeeding women. Because the treatment of mastitis at home - with suppuration of the focus of inflammation - is fraught with sepsis.

Thus, treatment of mastitis with cabbage leaf can reduce swelling and reduce local hyperthermia in lactostasis or in 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, the application of cabbage leaves to the sick chest will only do harm, because it takes two or three days, during which the inflammation will increase and lead to purulent mastitis.

Treatment of mastitis with camphor oil is possible only if the milk is stagnant, if the lactating woman has an overabundance, since camphor as a compress reduces the production of milk.

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

Do not rely on the action of warming compresses, because in inflammatory processes, thermal procedures are absolutely contraindicated. But with the stagnation of milk (when there is a strong engorgement of the gland), you can apply not only a light massage (including a warm shower), but alternating hot and cold compresses: a hot compress (for seven to eight minutes) helps improve blood circulation and cleanse milky ducts, and a cold compress (within three minutes) helps to reduce edema and relieve pain. But experts emphasize that this is done not with mastitis, but in cases of stagnant milk during lactation!