Haimerl P, Heuwieser W
Clinic for Animal Reproduction, Faculty of Veterinary Medicine, Freie Universität Berlin, 14163 Berlin, Germany.
Clinic for Animal Reproduction, Faculty of Veterinary Medicine, Freie Universität Berlin, 14163 Berlin, Germany.
J Dairy Sci. 2014 Nov;97(11):6649-61. doi: 10.3168/jds.2014-8462. Epub 2014 Sep 11.
Acute puerperal metritis (APM) is an acute systemic illness with fever ≥ 39.5 °C and signs of toxemia due to an infection of the uterus occurring within 21 d after parturition. Because of the infectious nature of APM, antibiotics are considered beneficial for its treatment. Each use of an antimicrobial drug, however, is associated with selective pressure for the emergence of resistant bacteria. Hence, there is a significant need to encourage prudent use of antibiotics and alternative therapies to antibiotics. Therefore, the objective of this study was to systematically review the current literature on treatment of APM. A comprehensive and systematic literature search was conducted utilizing the PubMed and CAB Abstracts databases to identify literature focusing on the antibiotic therapy of puerperal metritis in the cow. After application of specific exclusion criteria, 21 publications comprising 23 trials remained for final evaluation. Data extraction revealed that the majority of the studies (n = 19) were attributable to the highest evidence level. Of 21 studies controlled, 11 had an untreated group and 3 a positive control group. The majority of the studies (n = 17) applied ceftiofur for the treatment of APM. Concerning the efficacy of ceftiofur, 7 studies observed clinical improvement, whereas none found improved reproductive performance. Fewer than half of the studies (n = 10) performed a bacteriological examination and only 4 implemented an antibiotic susceptibility test. Also, 3 studies (13.0%) described a self-cure rate per se. Little attention was given to the issue of bacterial resistance (n = 3), the need for reducing the application of antibiotics (n = 2), or guidelines for prudent use of antibiotics (n = 1). Our findings demonstrate that implementation of bacteriological examinations, sensitivity testing, and determination of minimum inhibitory concentrations, as well as reporting and discussion of critical issues (e.g., self-cure rates, resistance, prudent drug use), were suboptimal. On the other hand, the quality of studies on the treatment of APM was good, as indicated by evidence level 1. Nevertheless, more high-quality research considering self-cure rates is necessary to address critical issues related to APM and crucial to the dairy industry, such as resistance, prudent use of antibiotics, animal welfare, and cost-benefit ratios.
急性产后子宫炎（APM）是一种急性全身性疾病，产后21天内发生子宫感染，伴有发热≥39.5°C及毒血症体征。由于APM具有感染性，抗生素被认为对其治疗有益。然而，每次使用抗菌药物都与耐药菌出现的选择性压力相关。因此，迫切需要鼓励谨慎使用抗生素以及采用抗生素替代疗法。所以，本研究的目的是系统回顾当前关于APM治疗的文献。利用PubMed和CAB文摘数据库进行了全面系统的文献检索，以确定聚焦于奶牛产后子宫炎抗生素治疗的文献。应用特定排除标准后，最终评估保留了21篇包含23项试验的出版物。数据提取显示，大多数研究（n = 19）属于最高证据水平。在21项对照研究中，11项有未治疗组，3项有阳性对照组。大多数研究（n = 17）应用头孢噻呋治疗APM。关于头孢噻呋的疗效，7项研究观察到临床改善，但无一发现繁殖性能改善。不到一半的研究（n = 10）进行了细菌学检查，只有4项进行了抗生素敏感性试验。此外，3项研究（13.0%）描述了自愈率本身。对细菌耐药性问题（n = 3）、减少抗生素应用的必要性（n = 2）或抗生素谨慎使用指南（n = 1）关注较少。我们的研究结果表明，细菌学检查、敏感性测试、最低抑菌浓度测定以及关键问题（如自愈率、耐药性、谨慎用药）的报告和讨论的实施情况并不理想。另一方面，如证据水平1所示，APM治疗研究的质量良好。然而，需要更多考虑自愈率的高质量研究来解决与APM相关的关键问题，这些问题对乳制品行业至关重要，如耐药性、抗生素的谨慎使用、动物福利和成本效益比。
