In the article, we consider antibiotics from mastitis for a nursing mother.
Mastitis refers to the process of inflammation, mainly of infectious origin, which affects the interstitial tissue and parenchyma of the breast. About 90% of breast lesions are associated with lactation and appear mainly in the first weeks after birth. The vast majority of cases of pathology occur in those who gave birth for the first time (from 70 to 75%), if the birth is repeated, their frequency decreases sharply.
What antibiotics can be used for mastitis, it is important to find out in advance.
The mammary gland is affected in the third and subsequent births in only 2%.
If mastitis has been diagnosed, it is necessary to differentiate it from paramastitis. This term includes other skin infectious and inflammatory diseases and pancreas of the mammary gland (erysipelas, phlegmon, abscesses, carbuncles and boils).
What antibiotics to take with mastitis, we consider below.
Causes of glandular inflammation and classification
The most common causes that contribute to the occurrence of mastitis are: mastopathy; stagnation of milk; cracked nipples; irregular feeding; improper attachment of the baby to the chest; sharp folding of lactation; insufficient decantation; non-compliance with hygiene rules; hypergalactia; immunodeficiency, tight underwear that compresses the mammary gland; a decrease in the natural resistance of the female body.
In postpartum mastitis, the clinical picture corresponds to the stages of their development:
- stage of pathological lactostasis;
- serous mastitis;
- infiltrative form;
- purulent mastitis: gangrenous, infiltrative-purulent, purulent-necrotic (phlegmonous), abscessed.
What antibiotics are prescribed for mastitis in women is interesting to many.
The main symptoms of pathology
Most often, milk stagnation occurs in the first week of lactation. The general well-being of a woman in the initial stages can be disturbed slightly. Temperature rises no more than 38 degrees. There are complaints of breast engorgement and its moderate soreness. At this stage of the disease, it is advisable to use non-medical treatment methods.
If symptoms progress, then serous mastitis is determined . This form of the disease is characterized by an increase in temperature of more than 38 degrees, a deterioration in well-being in general. Patients speak of severe weakness, breast pain, chills. When probing the chest, limited painful, tightened areas are felt. The skin integument is hyperemic near the halo. The affected chest increases in size over time.
If there is no adequate timely therapy, serous mastitis is transformed into infiltrative, in which the mammary gland is sharply painful and dense, the regional lymph nodes increase, and further suppuration of the infiltrate may occur.
Purulent forms are characterized by severe intoxication, severe fever, pain in the chest and in the regional lymph nodes. Such mastitis most often occurs as diffuse purulent infiltration with no abscess. Abscessed forms are less commonly observed. The outcome of such mastitis can be sepsis and even death. The most severe and rare form with a very poor prognosis is gangrenous mastitis.
When are mastitis antibiotics prescribed for a nursing mother?
The main factors of the inflammatory process of the mammary glands are bacterial infection and milk stasis. Stagnation of milk forms favorable conditions for the accelerated reproduction of the pathogenic flora (Klebsiella, strepto- and staphylococci, Pseudomonas aeruginosa and Escherichia coli), contributing to the appearance of pathology in the mammary gland.
The main danger of the disease lies in its rapid progression. If there is no timely therapy, pathological milk stasis first develops into serous, and then into an infiltrative type of mastitis (after 1-3 days). Within a few days, there may be suppuration of the infiltrate, turning it into a breast abscess or phlegmon, which require prompt surgical intervention. If there is no specialized assistance, a woman may die due to purulent mastitis. The cause is sepsis.
An antibiotic for mastitis in nursing women in this case can help.
Therefore, due to the likelihood of rapidly progressing and serious complications, treatment without medication. Namely: lymphatic drainage massage, applying a warm compress to the chest before feeding and after - cold decantation. Performing a gentle massage while feeding, drinking plenty of water and resting are advisable only at the stage of milk stagnation.
If the effect of treatment without medication is absent, within a day after determining the diagnosis, the doctor prescribes the use of mastitis antibiotics for a nursing mother.
Essential antimicrobial prescribing requirements
The antibiotic that is prescribed for a nursing mother with mastitis should meet the following criteria:
- be as safe as possible for a woman and her newborn baby;
- Not enough to pass into breast milk;
- have a wide spectrum of antimicrobial activity and affect the main pathogens;
- possess increased tropism to the tissues of the glands and form a sufficient concentration against microbes.
In this regard, drugs of the macrolide, cephalosporin and penicillin groups become recommended for use and safe antibiotics for mastitis in lactating women.
The use of chloramphenicol, fluoroquinolones, tetracyclines and sulfonamides is strictly prohibited. Lincosamides are prescribed only for health reasons, a woman minimizes lactation. The use of metronidazole in mastitis is the reason for the temporary stop of natural feeding.
So, what antibiotics to take with mastitis?
List of drugs
The following antibiotics are prescribed for mastitis for a nursing mother from the penicillin series: “Oxacillin”; "Benzylpenicillin"; Ampicillin "Flucloxacillin"; Amoxicillin / Clavulanate; "Dicloxacillin."
Macrolides are recommended for use: "Erythromycin"; Clarithromycin; "Josamycin"; "Azithromycin."
From among cephalosporins are appointed: "Cefazolin"; Ceftriaxone; "Cefoxitin"; Cefmetazole; "Cefuroxime."
Consider in more detail the antibiotics for mastitis that are resolved during breastfeeding.
The drug "Amoxiclav"
This amoxicillin, which is protected by clavulanic acid (a beta-lactamase inhibitor), is the "gold standard" for initial treatment for mastitis. The spectrum of its antimicrobial activity includes aerobic and anaerobic pathogens.
What is the dosage of an antibiotic for mastitis for a nursing mother? It is advisable to take in an amount of 500 plus 125 mg every eight hours, or 875 + 125 every twelve hours.
The drug is not prescribed for patients with renal failure, intolerance to beta-lactams, lymphocytic leukemia and cholestasis. If there is kidney failure, the dose is adjusted according to the glomerular filtration rate.
The most common side effects for the mother are: digestive tract disorders; dysbiosis; candidiasis; allergic reactions. For a baby with prolonged use, there is a likelihood of disturbance and sensitization of intestinal microflora. Therefore, the duration of therapy is agreed with the attending physician without fail.
What other antibiotics for mastitis that are allowed during breastfeeding are effective.
Cephalexin
This is a bactericidal agent of the first cephalosporin generation. It is used orally. It is active against the list of major pathogens. But compared with the second and third generations, it is excreted in larger quantities with breast milk. That is why a temporary cessation of breastfeeding may be recommended.
It is prescribed in an amount of 0.5 grams every six hours.
If a woman is allergic to cephalosporins, then the drug is contraindicated. Patients with reduced creatinine clearance have a dosage adjustment.
Ceftriaxone
It is a popular antibiotic compatible with breastfeeding for mastitis.
Included in the third cephalosporin generation. Used for injection. It is characterized by an extensive scope of antimicrobial activity, and is resistant to the vast majority of bacterial beta-lactamases.
With intolerance to cephalosporins and penicillins, it is not prescribed.
It is prescribed intramuscularly or intravenously at a thousand milligrams twice a day.
Patients tolerate the drug well, its use rarely causes side effects. As a rule, undesirable effects are manifested in the form of candidiasis, dysbiosis, phlebitis when administered intravenously, there may be allergic reactions.
"Flucloxacillin"
Another antibiotic compatible with breastfeeding for mastitis.
Included in the group of semi-synthetic penicillins. Affects bactericidal. It is effective against gram + and gram-cocci, gram-sticks (Salmonella, E. coli, Shigella, Klebsiella).
It is prescribed in a dosage of 250 milligrams (in tablet form) per day four times.
An antibiotic from mastitis in a nursing mother is not used in patients with individual sensitivity to penicillins and ophthalmic diseases.
The most common side effects are dyspeptic disorders, colitis, allergies, fungal inflammation of the mucous membranes, as well as a violation of the intestinal microflora.
Which antibiotic is better for mastitis, the doctor will tell.
Duration of the antibacterial course
Antibiotics in the treatment of mastitis are used from seven to ten days. It is strictly forbidden to take the medication earlier than two days after a perfect clinical recovery. In addition, it must be remembered that with the source of inflammation of the mammary glands in the form of staphylococci, antibiotic treatment should range from ten days to two weeks.
What antibiotics to drink from mastitis, not everyone knows.
The ability of antibiotics to penetrate into breast milk, their effect on the baby
Penicillin preparations in small quantities pass into milk. The lowest transition value for drugs with a wide spectrum of influence. This is due to the fact that these drugs are maximally connected with proteins of the blood plasma (the exception is only ampicillin) and are excreted intensively with urine.
Cephalosporins also get into milk to a low degree, about three percent of the antibiotic content in the blood, but with the inflammatory process of the mammary glands this indicator increases slightly.
When treating mastitis in women with antibiotics, caution should be exercised.
The second and third generations of cephalosporins are the least excreted in milk. In comparison with penicillins, the transition value is higher, but there is the possibility of allergic reactions in women and sensitization of the baby.
Macrolides perfectly get into milk and are able to create there a concentration of half as much as in blood. Because of this, cephalosporins and penicillins are significantly exceeded. But macrolides do not have a minimal toxic effect, a low likelihood of allergies and other complications from therapy by women, that is, they do not negatively affect the child. In this regard, drugs of this group can also be prescribed for female mastitis, if the patient does not want to curtail breastfeeding.
Antibiotics for mastitis can be purchased at any pharmacy.
Contraindications to other antibiotics
Aminoglycoside antibiotics do not get much into milk, but they have high toxic indicators for both a woman and her baby. They can cause hearing impairment and pseudomembranous colitis in a baby. In addition, there is a high probability of damage to the patient's kidneys.
Tetracyclines have a high value of excretion with milk of a woman on average 60-75% of the content in the blood. They have many undesirable effects and high toxicity. They can cause severe form of infant colitis (up to the death of the baby), a violation of the formation of dental primordia and bone growth.
Fluoroquinolones also have the ability to excrete in large quantities with milk. These are effective and at the same time very toxic medicines. The body carries them hard, there is a high probability of adverse events. Due to the fairly frequent complications of joints, kidneys, ligamentous apparatus, the appearance of photosensitization and the ability to impair skeleton formation, pregnant women, nursing mothers, and minor girls are not assigned.
Clindamycin is excreted in breast milk a little, but can cause severe pseudomembranous colitis. In high doses, lincomycin is secreted and often leads to a serious violation of microflora and the appearance of allergies in infants.
The effectiveness and safety of the use of other antimicrobial agents in the inflammatory process of the mammary gland has not been studied. Their purpose is not justified due to the lack of clinical information.
Features of antibiotic treatment of mastitis in a nursing woman
Physiotherapy is used to reduce lactostasis.
The lack of clinical improvement with antibacterial treatment for two days is an indication for surgical consultation to exclude abscess formation. If a woman has purulent or bilateral mastitis, use drugs that suppress lactation: Bromocriptine or Cabergoline, oral contraceptives or estrogens.
Oral antibiotic use is effective for infiltrative and serous types.
Surgical therapy is prescribed for purulent forms to open and drain the focus of sepsis. In this case, the woman is given intravenous antibiotics.
If there is a sharp pain, a novocaine retro-mammary block is done. Antimicrobial treatment is complemented by anti-inflammatory, immunomodulatory and detoxification.
Prevention of pathology includes seeking medical attention on time, the correct attachment of the baby to the chest, treatment of nipple cracks, pumping, hygiene and massage.
What antibiotics are prescribed for mastitis, now we know.
Recommendations for a nursing mother with mastitis
The problem of mastitis is of primary importance for nursing mothers. In any case, if antibiotic use cannot be avoided during treatment, lactation will have to be abandoned for a while, because some substances in the composition of such drugs penetrate into breast milk, which can become sources of intoxication or even poisoning the baby.
To maintain breastfeeding during antibiotic therapy for mastitis, a woman should regularly partially pump in incoming milk, and pumping at night is also possible. In addition, the following rules should be considered:
In the presence of an infiltrative stage of mastitis and an indication for antibiotic use, a nursing mother may have time to make a supply of breast milk for a while.
Particular attention should be paid to preserving the feeding, since with timely and proper treatment, you can continue to feed the baby after completing the course of taking the medicine.
In the event that mastitis has developed into a purulent stage, you can not give expressed milk to the baby, since it may contain hazardous substances.
If purulent mastitis, especially in case of complications, experts advise to complete breastfeeding, and a nursing mother, on the basis of a specific situation, can take measures to stop the production of breast milk and start taking the necessary medicines.
For patients in whom mastitis develops during breastfeeding, as a rule, doctors prescribe antibiotics with a wide spectrum of influence, for example, Amoxiclav, Ospamox, Cephalexin and others. Their advantage is that they have not only anti-inflammatory effects, but also antiparasitic, antibacterial and antimicrobial.
For example, the drug "Ospamox" is a drug of a number of amoxicillins. When the medication is taken by the patient, its greatest content is noted after 1-2 hours. The medicine penetrates perfectly into human tissues and biological fluids. With a particularly careful selection of the therapeutic dose, the concentration of the antibiotic in the milk is small.
When treating mastitis, nursing mothers are also prescribed Flemoxin. This is a first-line drug in outpatient practice. It is characterized as fairly safe, and therefore is often prescribed to patients during breastfeeding.
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- Leave the leaves that have cooled to room temperature with a meat hammer to make them look like a rag.
- Fold all the leaves in a container and put in the refrigerator. Use as a replacement.
With an uncomplicated type of lactostasis, a compress is enough just from a cabbage leaf applied to the affected breast during the day as it warms up.
When lactostasis is in an advanced state or mastitis develops, do composite compresses.
Other ingredients listed above are rubbed on a coarse grater, the juice is squeezed from them - so that it does not drip.
Compress is composed as follows:
- Take a plastic bag, tear it so that on the sides so that there is a long rectangle.
- Put two sheets on the bag approximately at the distance of the mammary glands, upward with a recess - to make two cups.
- Inside the cabbage cups, another grated ingredient, for example, carrots, is laid out in a thin layer with a seal on the problem areas.
- Carefully put the compress together with the package on the chest with cups and press on top with a bra.
- The structure around the body is wrapped on top with a soft, warm cloth.
How to choose ingredients for a compress?
Other ingredients that complement the effect of the cabbage leaf are several vegetables. Preference is given to beets. This vegetable is the most effective in eliminating the swelling of the mammary gland.
The main choice is made by the duration of the ingredient’s functioning: the grated potato acts no more than an hour and a half; carrots are left in a compress for one and a half to two hours; the action of beets - up to two and a half hours.
At night, therefore, it is better to make a compress of cabbage and beets, since you can not wake up every hour to change the cabbage leaf and ingredients.
Pathology prevention: what you need to know?
Knowing the difficulty of getting rid of mastitis, women often ask if it is possible to prevent this disease? Experts advise the following.
- Feed the baby on demand with breast milk.
- Correctly apply the baby.
- Breast-feed only for at least the first four months after birth.
- Refuse bottles and soothers.
- To carry out prophylaxis and heal on time the cracks of the nipple.
- Use comfortable linen.
- Avoid chest injuries.
- During the entire period of lactation, refuse serious physical work.
If you experience the first symptoms of mastitis, you should consult a doctor or breastfeeding consultant.
We examined antibiotics for mastitis in women.