Endometritis & metritis
Traditional treatment
Traditional treatments available for endometritis include antibiotics, hormones and intrauterine antiseptics.
ANTIBIOTICS
For decades, endometritis in cows has been treated with intrauterine infusion. With this infusion, the uterus could be rid of bacteria. However, there is little evidence that the infusion eliminates the endometrial inflammation or restores fertility. Many preparations routinely administered into the bovine uterus are detrimental to uterine tissue. Preventive antibiotic treatment postpartum may cause more infection than already present and it is an expensive practice trough loss of milk plus the costs of drugs.
Thereby, the concern about milk and carcass residues has been increased as well as poor or uncertain results should disheart the routined use of intrauterine infusions for managing endometritis in cattle. Simultaneous biopsy sampling and uterine cultures can positively confirm the presence of endometritis and the presence or absence of organisms in the uterus. Intrauterine therapy with antibiotics or antiseptics when cultures are negative has little value. In fact, some researchers feel unnecessary therapy may have a detrimental effect on conception. (1)
Various factors should be considered when selecting an antibiotic for the treatment of endometritis. Criteria for antibiotic:
Generally, a broad spectrum antibiotic, active against Actinobaccillus pyogenes and gram-negative anaerobes should be used. Ideal antibiotics are cephalosporins and oxytetracycline as they match the majority of criteria listed above. Some resistance to oxytetracyclines is reported and additionally some formulations cause irritation to the endometrium, therefore intrauterine cephalosporin should be considered the most effective antibiotic treatment.
Sulphonamides, aminoglycosides, and penecillins have decreased activity as a result of the uterine environment and bacteria present. Metranidazole and chloramphenicol should not be used as they are banned from use in food-producing animals.
Some antibiotics are rapidly absorbed and distributed throughout the body, and in these cases it may be of more use to administer them parenterally. (3)
Intrauterine infusion of cephapirin in a form specially formulated for intrauterine use (Benzathinecephapirine) has enhanced fertility in dairy cows with endometritis. On most drug labels for intrauterine therapy, there are no recommended doses. Withdrawl times for milk/slaughter after treatment with drugs used for intrauterine injections are frequently not available. Withholding times for milk depends on the concentration and number of treatments that a drug has been used. (1,2)
Thereby, the concern about milk and carcass residues has been increased as well as poor or uncertain results should disheart the routined use of intrauterine infusions for managing endometritis in cattle. Simultaneous biopsy sampling and uterine cultures can positively confirm the presence of endometritis and the presence or absence of organisms in the uterus. Intrauterine therapy with antibiotics or antiseptics when cultures are negative has little value. In fact, some researchers feel unnecessary therapy may have a detrimental effect on conception. (1)
Various factors should be considered when selecting an antibiotic for the treatment of endometritis. Criteria for antibiotic:
- appropriate efficacy in infected uterine environment
- appropriate efficacy against the causal bacteria
- no inhibition of natural uterine defense mechanisms
- appropriate concentration and duration of action in the infected uterine lumen
- little or no milk withdrawal period
- cost effective
- no detrimental effect on fertility
Generally, a broad spectrum antibiotic, active against Actinobaccillus pyogenes and gram-negative anaerobes should be used. Ideal antibiotics are cephalosporins and oxytetracycline as they match the majority of criteria listed above. Some resistance to oxytetracyclines is reported and additionally some formulations cause irritation to the endometrium, therefore intrauterine cephalosporin should be considered the most effective antibiotic treatment.
Sulphonamides, aminoglycosides, and penecillins have decreased activity as a result of the uterine environment and bacteria present. Metranidazole and chloramphenicol should not be used as they are banned from use in food-producing animals.
Some antibiotics are rapidly absorbed and distributed throughout the body, and in these cases it may be of more use to administer them parenterally. (3)
Intrauterine infusion of cephapirin in a form specially formulated for intrauterine use (Benzathinecephapirine) has enhanced fertility in dairy cows with endometritis. On most drug labels for intrauterine therapy, there are no recommended doses. Withdrawl times for milk/slaughter after treatment with drugs used for intrauterine injections are frequently not available. Withholding times for milk depends on the concentration and number of treatments that a drug has been used. (1,2)
Argumentation:
- Trimethoprim / sulphonamide combinations are not
effective against anaerobes.
- Trimethoprim / sulphonamide combinations are not effective in the formation of pus and necrosis.
(1,2,17)
HORMONES
Before treatment with antibiotics, hormones -like
prostaglandins- are routinely used by vets to induce heat. As told in the
description of the disease, estrus helps to expel the infection from the uterus. (3)
ANTISEPTICS
Antiseptic administered intrauterine (Chlorhexidine and metakresol
sulphonic acid (Lotagen)) are reported to be
a effective alternative to antibiotic treatment. However, a few studies have
been carried out to confirm this and detrimental effects on fertility are
reported. (3)