Evaluation of two doses of ceftiofur crystalline free acid sterile suspension for treatment of metritis in lactating dairy cows

Abstract

The objectives of this study were to evaluate efficacy of a 2-dose regimen of ceftiofur crystalline free acid sterile suspension (CCFA-SS) for treatment of acute metritis in lactating dairy cows under field conditions and to provide additional safety and injection site tolerance data for injections at the base of the ear. Cows at 15 dairies with rectal temperature ≥ 39.5°C and fetid uterine discharge ≤ 10 d postcalving were randomly assigned by blocks of 2, based on order of entry and without regard to parity, to treatment with saline (1.5 mL/45.5 kg of body weight, n=509) or CCFA-SS (6.6 mg of ceftiofur equivalents/kg of body weight, n=514). Treatments were administered by subcutaneous injection in the posterior aspect of the ear where it attaches to the head; the first dose was administered on study d 0 and the second dose was administered in the contra lateral ear on study d 3. Rectal temperatures were recorded on study d 1 to 4 and 5 or 6 and cows were clinically evaluated daily from study d 1 to 13. Cows that exhibited increased adverse clinical signs of poor health or complications associated with metritis were categorized as a treatment failure and administered escape therapy. Each cow received a veterinary physical examination on study d 5 or 6 to determine if she should be removed from the study and on study d 14 to determine clinical cure or failure to cure. Clinical cure was defined as rectal temperature <39.5°C and non-fetid and purulent or mucopurulent discharge on study d 14 and no escape therapy administered. The injection procedure was scored after each injection (study d 0 and 3) and injection sites and ear carriage were scored on study d 5 or 6, 14, and 57±3. Of the 1,023 cows enrolled, 7 were completely censored due to protocol deviations and 34 were removed for protocol deviations or medical conditions not related to metritis. Clinical cure rate was higher for CCFA-SS than for saline (74.3 vs. 55.3%) and rectal temperatures for each of study d 1 to 5 or 6 were lower for CCFA-SS than saline. Injection procedure indices showed that CCFA-SS could be practically and safely administered using commercial dairy facilities. Although injection site scores were higher for CCFA-SS than saline at study d 5 or 6 and 14, ≥98.6% of ears were normal on d 57±3. Thus, a 2-dose treatment with CCFA-SS given 72h apart increased metritis clinical cure rate and was well tolerated in dairy cows.

Reproductive tract inflammatory disease in postpartum dairy cows

“…Recent studies have shown conflicting results on the efficacy of a single dose of long-acting ceftiofur (crystalline fee acid) to reduce the incidence of metritis in cows with risk factors at calving McLaughlin et al, 2013). There are data to support treatment of cows with metritis with ceftiofur or penicillin (LeBlanc, 2008;McLaughlin et al, 2012), but clinical cure is only around 75% to 80% over 10 to 14 days as compared with 62% in untreated cases (Chenault et al, 2004). The impacts of treatment for metritis on subsequent health and reproductive performance are unclear and studies with longer follow-up are needed.…”

“…Concentrations of drug are not maintained consistently above the target levels in the uterus in cows with metritis (von Krueger et al, 2013). Spontaneous clinical resolution occurs in some cases (Chenault et al, 2004;McLaughlin et al, 2012) and preliminary data suggest that delay of a few days in the onset of treatment of metritis -a 'wait-and-see' approach to allow for spontaneous resolution in perhaps 20% of cases -is worth testing in larger randomized clinical trials.…”

Evidence for the Use of Ceftiofur for Treatment of Metritis in Dairy Cattle

“…The six articles used for this study were written in English. Of the six articles, five 6,13,[25][26][27] were considered high quality (scores 86, 68, 70, 88, 74) and one 12 was considered intermediate quality (score 51). Three 13,25,27 of the six articles had untreated negative control groups and three 6,12,26 had treated positive control groups.…”

“…Efficacy of ceftiofur was measured by clinical cure in the six articles. The clinical cure as a response to treatment was defined as a decrease in rectal temperature alone 6,12,13 ; a combination of a decrease in rectal temperature and absence of fetid vaginal discharge 13,25,26 ; or a decrease in rectal temperature, an absence of fetid vaginal discharge, and no additional antibiotic therapy needed. 27 Other parameters evaluated included reproductive performance, 6,25,26 milk production, 12,24 endometritis, 25 acute-phase proteins, 12 and financial analysis.…”

“…Metritis was defined as an elevated rectal temperature (>39.5 C [103.1 F] in four articles 6,13,26,27 and >39.2 C [102.6 F] in two articles 12,25 ) with fetid red-brown vaginal discharge occurring within the first 21 days in milk. Efficacy of ceftiofur was measured by clinical cure in the six articles.…”