Antibiotics for mastitis in women: lactation, non-lactational, purulent

Many women are familiar with such a disease as mastitis. It has several separate varieties, but it is usually divided into non-purulent and purulent forms. The treatment method depends on the form of the pathology. Antibiotics for mastitis are almost always prescribed to patients, since with the non-purulent type of the disease they are used to prevent the development of infection, and with a more severe form, they destroy pathogenic microflora.

[ 1 ]

Indications antibiotics for mastitis

There are several indications and conditions in patients with mastitis that allow antibiotics to be prescribed for treatment:

• local or widespread purulent inflammatory process inside the tissues of the mammary gland (such as phlegmon, abscess or necrosis);
• the patient's general health condition deteriorates, intoxication of the body and high temperature persist for more than 3 days, despite therapy with other medications;
• mastitis in chronic or recurrent form;
• regular microdamage (cracks or scratches) to the nipples in patients with reduced tissue healing capacity, as well as with immunodeficiency states;
• diseases of other systems and organs that can complicate the course of mastitis (diseases such as high blood pressure, heart or kidney failure, diabetes, etc.).

[ 2 ]

Release form

They are available in the form of tablets, capsules, and injection solutions.

Names of antibiotics for mastitis

The most popular medications that help get rid of pathogenic microbes are:

• Ampicillin (such drugs as Ampyrex, Dekapen, and also Pentarcin and Epicocillin), which is included in the penicillin category. It is able to work effectively in the acidic environment of the stomach, as a result of which it can be used in tablet form;
• Amoxicillin (such drugs as Amoxicar with Amosin, as well as Ospamox, Hikoncil, Gonoform, Ranoxil, and also Flemoxin-Solutab), which effectively copes with pyogenic staphylococci;
• Cefuroxime (such drugs as Axetin with Multisef, in addition to this Kefstar, Ucefaxime, Zinnat, etc.) is a cephalosporin drug that effectively eliminates staphylococci, as well as strains resistant to antibiotics from the penicillin group;
• Cefazolin (such drugs as Zolfin and Orizolin, as well as Ancef and Cefopride with Cefamezin) is an antibiotic with a broad spectrum of action. This drug is administered as an intravenous or intramuscular injection;
• Soluble Streptocide is a sulfanilamide. It is produced in the form of an ointment, which is used externally.

[ 3 ], [ 4 ]

Antibiotics for purulent mastitis

All the above antibiotics (Amoxicillin, Ampicillin, as well as Cefazolin with Cefuroxime and soluble Streptocide) have the properties necessary for the treatment of purulent mastitis.

[ 5 ], [ 6 ]

Antibiotics for non-lactational mastitis

The infiltrative form of non-lactational mastitis is treated with antibiotic tablets:

• "protected" and "unprotected" forms of semi-synthetic penicillins (drugs such as amoxicillin, as well as amoxiclav, etc.);
• 1st and 2nd generation cephalosporins (cephalexin with cefuroxime, etc.).

Antibiotics of other categories may be prescribed if resistance of pathogenic microbes to the above-mentioned drugs has been identified. Among these are: aminoglycosides (such as gentamicin), as well as fluoroquinolones (such as ciprofloxacin).

The properties of antibiotics for mastitis are discussed using the drug Ampicillin as an example.

[ 7 ], [ 8 ], [ 9 ], [ 10 ]

Pharmacodynamics

The medicine has a wide range of antibacterial properties, as well as a bactericidal effect.

It inhibits the activity of transpeptidase, prevents the formation of bonds between peptides, and also destroys the final stages of the synthesis of murein in the cell wall of a microorganism in the process of division, and provokes bacterial lysis.

Ampicillin also actively affects a large number of gram-positive microbes (α-, as well as β-hemolytic streptococci, as well as pneumococci, staphylococci, Bacillus anthrax and clostridia), Listeria spp., as well as gram-negative microbes (influenza bacillus, meningococcus, gonococcus, Proteus mirabilis, Yersinia multocida (Pasteurella), salmonella, shigella, Bordetella spp., as well as Escherichia coli) and non-spore-forming aerobes. Moderately affects many enterococci, including Enterococcus faecalis.

It has no effect on penicillinase-producing strains of staphylococci, all strains of Pseudomonas aeruginosa, most strains of Klebsiella, as well as enterobacteria and indole-positive Proteus vulgaris.

[ 11 ], [ 12 ]

Pharmacokinetics

After oral administration, the drug is absorbed from the gastrointestinal tract (about 30-40% of the dosage), and peak concentration is reached after 1.5-2 hours.

A small part of the active substance (approximately 10-30%) binds to plasma proteins. Distribution occurs in most tissues with organs. Therapeutic concentrations of the active component are found in synovial, peritoneal, and pleural fluids. It passes poorly through the BBB, but in case of inflammation of the meninges, permeability increases. The drug almost does not undergo biotransformation.

Excretion occurs mainly through the kidneys (unchanged substance), large concentrations of the substance are formed in the urine. Partially excreted with bile, and in lactating mothers - with milk. No accumulation occurs.

[ 13 ], [ 14 ], [ 15 ], [ 16 ]

Dosing and administration

The daily dosage of Ampicillin is 2-3 g. It should be divided into 4-6 doses.

To treat mastitis, Amoxicillin should be taken for 5 days at a dosage of 0.5 g three times a day (it is recommended to do this at equal time intervals).

Soluble Streptocide is an ointment for external use - it should be applied to the affected area of the chest (1-2 times a day), and then a sterile gauze bandage should be applied to the treated surface.

[ 26 ], [ 27 ]

Use antibiotics for mastitis during pregnancy

Pregnant and lactating women can be prescribed the antibiotic Hikoncil. Also, during pregnancy, it is allowed to use Flemoxin-Solutab (but only in cases of detection of prenatal mastitis).

The drugs Cefuroxime and Cefazolin are contraindicated during lactation and pregnancy.

Antibiotics for Mastitis During Breastfeeding

During the lactation period, antibiotics against mastitis can be administered intravenously or intramuscularly, or taken orally in tablet form. Such a course of treatment lasts for 5-10 days (the exact amount depends on the effectiveness of the therapy, as well as the form of the disease).

[ 17 ], [ 18 ], [ 19 ], [ 20 ]

Contraindications

The main contraindication for any type of antibiotics is individual intolerance to the components of the drugs (penicillins, cephalosporins, sulfonamides, etc.). Ampicillin with Amoxicillin cannot be used in the presence of infectious mononucleosis.

Ampicillin is also prohibited if the patient has liver failure, lymphocytic leukemia, or a history of gastrointestinal diseases (especially colitis caused by taking antibiotics).

Streptocide soluble cannot be used in the presence of Graves' disease, as well as renal pathologies and diseases associated with the hematopoietic system.

[ 21 ], [ 22 ]

Side effects antibiotics for mastitis

After taking Ampicillin, the following side effects may develop:

• nervous system organs: development of seizures (as a result of treatment with large doses), tremors, and headaches;
• cardiovascular and hematopoietic systems: development of anemia, agranulocytosis, neutro-, thrombocyto- and leukopenia.

The following side effects are possible as a result of taking Amoxicillin:

• Allergy: rhinitis, skin hyperemia, conjunctivitis, foliaceous dermatitis, and also MEE. In addition, anaphylaxis, angioedema, urticaria, malignant erythema multiforme, severe itching, maculopapular rash and reactions similar to serum sickness;
• gastrointestinal tract: vomiting with nausea, diarrhea, development of glossitis and stomatitis, and in addition, pain in the anus and changes in taste sensations;
• nervous system organs: feelings of anxiety, agitation, dizziness or headaches, in addition to convulsions, development of insomnia, changes in behavior and confusion;
• organs of the hematopoietic and cardiovascular systems: development of tachycardia, transient anemia, Werlhof's disease, neutro- or leukopenia, as well as agranulocytosis or eosinophilia;
• others: development of breathing problems, arthralgia, tubulointerstitial nephritis, and moderate increase in liver transaminase levels. Complications due to chemotherapeutic effects are also possible - development of dysbacteriosis, candidiasis in the vagina or oral cavity, as well as superinfection (especially in patients with chronic diseases or reduced body resistance) and pseudomembranous or hemorrhagic colitis.

Side effects of taking Cefuroxime:

• nervous system organs: drowsiness, headaches, and hearing loss;
• cardiovascular and hematopoietic systems: decreased hemoglobin levels, as well as hematocrit, development of transient forms of eosinophilia, as well as neutro- or leukopenia, hemolytic or aplastic anemia, agranulocytosis, thrombocytopenia, hypoprothrombinemia, and in addition, an increase in prothrombin time;
• Gastrointestinal organs: vomiting with nausea, diarrhea or constipation, bloating, pain or cramps in the abdomen, dyspeptic symptoms. In addition, the appearance of ulcers in the oral cavity, the development of glossitis, anorexia, pseudomembranous colitis and a feeling of thirst, a transient increase in the activity of transaminases, LDH, alkaline phosphatase or bilirubin. The development of cholestasis or liver dysfunction is also possible;
• genitourinary system: kidney dysfunction, increased levels of creatinine or urea nitrogen in the blood serum, decreased creatinine clearance rate, itching in the perineum, development of vaginitis or dysuria;
• allergy: itching, skin rashes and urticaria, as well as bronchospasms, the appearance of chills or drug fever, the development of serum sickness, tubulointerstitial nephritis, erythema multiforme, anaphylaxis, and malignant exudative erythema;
• others: pain in the sternum, shortening of the respiratory process, development of superinfection, dysbacteriosis or candidiasis (also in the oral cavity), convulsions (in the presence of renal failure), determination of a positive Coombs test. Among local reactions: compaction or pain at the injection site or thrombophlebitis after intravenous administration.

When using soluble Streptocide, the following reactions are possible: dizziness or headaches, vomiting with nausea, development of cyanosis, allergy, leukopenia or agranulocytosis. Tachycardia or paresthesia may also be observed.

[ 23 ], [ 24 ], [ 25 ]

Overdose

In case of overdose of Ampicillin, toxic effect on the function of the central nervous system is observed (especially in patients with renal failure). Symptoms include vomiting with nausea, diarrhea, and destabilization of water-electrolyte balance.

Gastric lavage and administration of saline laxatives together with activated carbon are prescribed. Symptomatic treatment is also carried out and normal water-electrolyte balance is maintained. The substance is removed by hemodialysis.

In case of overdose of Cefuroxime, convulsions and symptoms of CNS excitation are observed. To eliminate the disorders, anticonvulsants, peritoneal dialysis with hemodialysis are prescribed, and the vital functions of the body are also supported.

[ 28 ], [ 29 ]

Interactions with other drugs

Ampicillin has pharmaceutical incompatibility with aminoglycosides. Due to the combination with allopurinol, the risk of skin rashes increases. Combination with oral drugs containing estrogen reduces the effectiveness of oral contraceptives, and the combination with ethinyl estradiol reduces the effect of the latter, thereby reducing the risk of breakthrough bleeding.

Ampicillin increases the effectiveness of oral anticoagulants, as well as aminoglycoside antibiotics. In combination with antibiotics with bactericidal properties (such as cephalosporins, rifampicin, as well as vancomycin and aminoglycosides), synergism of their action is observed, and with antibiotics with bacteriostatic properties (such as lincosamides, macrolides, as well as tetracyclines, chloramphenicol and sulfonamides), antagonism is observed.

Diuretic drugs, tubular secretion blockers, probenecid, allopurinol and NSAIDs (also phenylbutazone) weaken the processes of tubular secretion and increase ampicillin levels.

Cefuroxime in combination with diuretics and nephrotoxic antibiotics increases the risk of negative effects on the kidneys; in combination with NSAIDs, the risk of bleeding increases.

Probenecid weakens the process of tubular secretion and reduces the renal clearance rate (approximately -40%). In addition, it also increases the peak concentration of cefuroxime (approximately +30%), the half-life of serum (approximately +30%), and in addition its toxic properties.

Drugs that reduce gastric acidity reduce the rate of absorption and bioavailability of cefuroxime.

[ 30 ], [ 31 ]

Storage conditions

The storage conditions for antibiotics for mastitis are standard for medications (a dark, dry place with a temperature of no more than 25°C, inaccessible to children).

[ 32 ], [ 33 ], [ 34 ], [ 35 ], [ 36 ]

Shelf life

Antibiotics for mastitis are recommended to be used for 2-4 years from the date of manufacture.

[ 37 ], [ 38 ], [ 39 ]