Mammary Gland Inflammation (Mastitis): Drug Therapy

Therapy goals

  • Elimination of the pathogens or the complaints.
  • Avoidance of complications

Therapy recommendations

  • Mastitis puerperalis (inflammation of the mammary glands during the puerperium)
    • Emptying (“drinking empty”) the breast or expressing the milk and, in the early stages, cooling the breast (cooling compresses) Note: Weaning is not required on a regular basis! (Prolactin inhibitor is not a routine therapeutic for mastitis puerperalis).
    • Analgesics (“painkillers“): paracetamol or ibuprofen.
    • If necessary, antibiosis (antibiotic therapy): β-lactamase-resistant penicillins or first- and second-generation cephalosporins; macrolide antibiotics are indicated if penicillin is allergic. Notice:
      • Do not prescribe antibiotics too “early” because this is associated with the risk of microabscess formation; also, do not prescribe antibiotics too late because of the risk of progression of inflammation (inflammation) to abscess formation (abscess formation/formation of a pus cavity: see following remarks).
      • If there is no improvement after 48 to 42 hours of antibiotic therapy, sonography is required to rule out abscess formation.
  • Mastitis non-puerperalis (inflammation of the mammary glands outside pregnancy or the puerperium).
    • Antibiosis (antibiotic therapy): lincosamide (1st choice drug), duration of therapy 7-10 days.
    • If necessary, prolactin inhibitors
  • Abacterial mastitis (non-bacterial mastitis).
    • Granulomatous mastitis (GM): glucocorticoid therapy.
    • Plasma cell mastitis (chronic inflammation of the mammary glands in which so-called plasma cells predominate): Glucocorticoid therapy
  • Abscess formation (formation of a pus cavity):
    • If necessary, heat application to help the process of inflammatory tissue liquefaction,
    • Abscess drainage, alternatively surgical incision and counter-incision.
    • Antibiotics
    • Analgesics, if necessary
  • See also under “Further therapy”.

Further notes

  • In cases of mastitis outside the puerperium (mastitis non puerperalis), great caution is recommended before immediate invasive measures. After healing of mastitis, however, a malignancy (breast cancer) should be excluded!