全職媽，寶貝1m16d，全母乳
目前深受乳線炎之苦，硬塊佔據一半乳房也化膿了，
現在吃抗生素治療中可是怎麼擠膿都不出來，
真的不想住院打抗生素，想在剩的六天在家把膿跟硬塊處理
好，請有經驗媽媽分享，已經換三家醫
院了......
給媽媽的建議: 1.乳汁移出效果不彰時 要考慮是否乳腺炎處於急性期 結締組織受發炎病
灶波及 此時用藥不夠或種類未針對菌叢時 會拖延病情 更難治療 有可能皮膚破損膿奶未
必從乳頭排出 2. 每位媽媽乳腺炎症狀都不同 感染到的菌也需培養才知道是哪一群 如果不
是目前口服抗生素可以對抗的 還是需要換藥物種類 不是自己能夠用一般程序消除硬塊
以下文獻請媽媽用翻譯軟體看看
參考文獻 BREASTFEEDING MEDICINE
Volume 9, Number 5, 2014
ª Mary Ann Liebert, Inc.
DOI: 10.1089/bfm.2014.9984
乳腺炎診斷定義 : Definition and Diagnosis
The usual clinical definition of mastitis is a tender, hot,
swollen, wedge-shaped area of breast associated with temperature
of 38.5C (101.3F) or greater, chills, flu-like aching,
and systemic illness.5 However, mastitis literally means, and is
defined herein, as an inflammation of the breast; this inflammation
may or may not involve a bacterial infection.6,7 Redness,
pain, and heat may all be present when an area of the
breast is engorged or ‘‘blocked’’/‘‘plugged,’’ but an infection
is not necessarily present. There appears to be a continuum
from engorgement to noninfective mastitis to infective mastitis
to breast abscess.7 (II-2)
誘發因素 Predisposing Factors
The following factors may predispose a lactating woman
to the development of mastitis.7,8 Other than the fact that
these are factors that result in milk stasis, the evidence for
these associations is generally inconclusive (II-2):
1. Damaged nipple, especially if colonized with Staphylococcus
aureus
2.Infrequent feedings or scheduled frequency or duration
of feedings
3. Missed feedings
4. Poor attachment or weak or uncoordinated suckling
leading to inefficient removal of milk
5. Illness in mother or baby
6.Oversupply of milk
7.Rapid weaning
8. Pressure on the breast (e.g., tight bra, car seatbelt)
9. White spot on the nipple or a blocked nipple pore or
duct: milk blister or ‘‘bleb’’ (a localized inflammatory
response)9
10.Maternal stress and fatigue
Management 處理
Effective milk removal
Because milk stasis is often the initiating factor in mastitis,
the most important management step is frequent and effective
milk removal:
Mothers should be encouraged to breastfeed more frequently,
starting on the affected breast.
If pain interferes with the let-down, feeding may begin
on the unaffected breast, switching to the affected
breast as soon as let-down is achieved.
Positioning the infant at the breast with the chin or nose
pointing to the blockage will help drain the affected
area.
Massaging the breast during the feed with an edible oil
or nontoxic lubricant on the fingers may also be helpful
to facilitate milk removal. Massage, by the mother or a
helper, should be directed from the blocked area
moving toward the nipple.
After the feeding, expressing milk by hand or pump
may augment milk drainage and hasten resolution of
the problem.11 (III)
An alternate approach for a swollen breast is fluid mobilization,
which aims to promote fluid drainage toward the
axillary lymph nodes.12 The mother reclines, and gentle hand
motions start stroking the skin surface from the areola to the
axilla.12 (III)
There is no evidence of risk to the healthy, term infant
of continuing breastfeeding from a mother with mastitis.7
Women who are unable to continue breastfeeding should
express the milk from breast by hand or pump, as sudden
cessation of breastfeeding leads to a greater risk of abscess
development than continuing to feed.11 (III)
Supportive measures
Rest, adequate fluids, and nutrition are important measures.
Practical help at home may be necessary for the mother
to obtain adequate rest. Application of heat—for example, a
shower or a hot pack—to the breast just prior to feeding may
help with the let-down and milk flow. After a feeding or after
milk is expressed from the breasts, cold packs can be applied
to the breast in order to reduce pain and edema.
Although most women with mastitis can be managed as
outpatients, hospital admission should be considered for
women who are ill, require intravenous antibiotics, and/or do
not have supportive care at home. Rooming-in of the infant
with the mother is mandatory so that breastfeeding can
continue. In some hospitals, rooming-in may require hospital
admission of the infant.
Pharmacologic management 藥物處置
Although lactating women are often reluctant to take
medications, women with mastitis should be encouraged to
take appropriate medications as indicated.
Analgesia. Analgesia may help with the let-down reflex
and should be encouraged. An anti-inflammatory agent such
as ibuprofen may be more effective in reducing the inflammatory
symptoms than a simple analgesic like paracetamol/
acetaminophen. Ibuprofen is not detected in breastmilk following
doses up to 1.6 g/day and is regarded as compatible
with breastfeeding.13 (III)
Antibiotics. If symptoms of mastitis are mild and have
been present for less than 24 hours, conservative management
(effective milk removal and supportive measures) may
be sufficient. If symptoms are not improving within 12–24
hours or if the woman is acutely ill, antibiotics should be
started.7 Worldwide, the most common pathogen in infective
mastitis is penicillin-resistant S. aureus.
14,15 Less commonly,
the organism is a Streptococcus or Escherichia coli.
11 The
preferred antibiotics are usually penicillinase-resistant penicillins,5
such as dicloxacillin or flucloxacillin 500 mg by
mouth four times per day,16 or as recommended by local
antibiotic sensitivities. (III) First-generation cephalosporins
are also generally acceptable as first-line treatment, but may
be less preferred because of their broader spectrum of coverage.
(III)
Cephalexin is usually safe in women with suspected penicillin
allergy, but clindamycin is suggested for cases of severe
penicillin hypersensitivity.16 (III) Dicloxacillin appears
to have a lower rate of adverse hepatic events than flucloxacillin.17
Many authorities recommend a 10–14-day course of
antibiotics18,19; however this recommendation has not been
subjected to controlled trials. (III)
S. aureus resistant to penicillinase-resistant penicillins
(methicillin-resistant S. aureus [MRSA], also referred to as
oxacillin-resistant S. aureus) has been increasingly isolated
in cases of mastitis and breast abscesses.20–22 (II-2) Clinicians
should be aware of the likelihood of this occurring in
their community and should order a breastmilk culture and
assay of antibiotic sensitivities when mastitis is not improving
48 hours after starting first-line treatment. Local resistance
patterns for MRSA should be considered when
choosing an antibiotic for such unresponsive cases while
culture results are pending. MRSA may be a communityacquired
organism and has been reported to be a frequent
pathogen in cases of breast abscess in some communities,
particularly in the United States and Taiwan.21,23,24 (I, II-2)
At this time, MRSA occurrence is low in other countries,
such as the United Kingdom.25 (I) Most strains of methicillinresistant
staphylococci are susceptible to vancomycin or
trimethoprim/sulfamethoxazole but may not be susceptible
to rifampin.26 Of note is that MRSA should be presumed to
be resistant to treatment with macrolides and quinolones,
regardless of susceptibility testing results.27 (III)
As with other uses of antibiotics, repeated courses place
women at increased risk for breast and vaginal Candida
infections.
