Mastitis O91.1

Bacterial abscessing mastitis. In about 2/3 of cases mastitis puerperalis, in 1% of women in childbed, 95% due to Staphylococcus aureus. Transmission in most cases is through the mouth of the child, favored by milk stasis and rhagade formation of the nipple.

Non-puerperal mastitis occurs predominantly in smokers and young girls. It is favored by nipples and hyperprolactinemia.

Onset with circumscribed redness, induration, and pain.
Subcutaneous, intramammary, glandular, retromammary, or subareolar abscesses. Pain, fever, chills, redness, and fluctuation. In non-puerperal mastitis, there is usually no fever.

• Cool, moist compresses, apply frequently to children.
• Envelopes with Retterspitz® external solution
• Curd compresses: wrap cotton cloth and spread curd on it, wrap breast with it for 30 minutes.
• Permanent wearing of a well-fitting, tight bra.
• Erysidoron®1 (Weleda), 5 drops hourly; if no improvement: Erysidoron®2 alternating with Erysidoron®1 1 tbl. hourly, if improvement 3xtägl. 1 tbl.
• for sore nipples: apply lanolin, witch hazel or oak bark extract, St. John's wort oil, cooled black tea bags.
• If signs of inflammation do not subside: amoxicillin/clavulanic acid 3 x 875mg/125mg for 7 days or
• Clindamycin 600mg 3x1 over 7 days.
• Anti-inflammatories.
• In case of abscess formation: puncture, weaning if necessary, incision and drainage.
• In case of mastitis nonpuerperalis additionally if necessary prolactin lowering drugs for weeks and months.

Special form of thrush mastitis:

• dry eczematous nipples, whitish stipples; burning pain during breastfeeding is typical; oral thrush of the infant.
• Diagnosis by smear test with moist cotton swab
• always treat mother and child simultaneously with miconazole gel, e.g. Daktar® oral gel, for at least 14 days
• Cleaning of the breast with boiled water, vinegar water (1 tsp. vinegar in a cup of water) or rose hydrolate, then drying
• in therapy-resistant cases fluconazole orally (mother 200mg/d, infant 3-6mg/kg bw).

Cave: In all types of mastitis, if symptoms persist beyond four weeks, always exclude inflammatory breast carcinoma!