Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, C.P. 5000, St-Hyacinthe, QC, J2S 7C6, Canada.
Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, C.P. 5000, St-Hyacinthe, QC, J2S 7C6, Canada; Canadian Bovine Mastitis and Milk Quality Research Network, C.P. 5000, St-Hyacinthe, QC, J2S 7C6, Canada.
J Dairy Sci. 2017 Oct;100(10):7751-7770. doi: 10.3168/jds.2016-12512. Epub 2017 Jul 26.
Clinical mastitis is an important disease in dairies. Its treatment is mainly based on the use of antimicrobial drugs. Numerous non-antimicrobial drugs and treatment strategies have already been reported for clinical mastitis treatment, but data on their efficacy have never been collated in a systematic way. The objective of this systematic review was to identify treatments other than conventional antimicrobials for the treatment of clinical mastitis in lactating dairy cows. A systematic review was performed with studies written in English or French selected from CAB Abstracts, PubMed, and Web of Science from January 1970 to June 2014. Controlled clinical trials, observational studies, and experimental challenges were retained. Lactating dairy cows with clinical mastitis were the participant of interest. All treatments other than conventional antimicrobials for clinical mastitis during lactation were retained. Only studies comparing the treatment under investigation to a negative or positive control, or both, were included. Outcomes evaluated were clinical and bacteriological cure rates and milk production. Selection of the study, data extraction, and assessment of risk of bias was performed by 3 reviewers. Assessment of risk of bias was evaluated using the Cochrane Collaboration tool for systematic review of interventions. A total of 2,451 manuscripts were first identified and 39 manuscripts corresponding to 41 studies were included. Among these, 22 were clinical trials, 18 were experimental studies, and 1 was an observational study. The treatments evaluated were conventional anti-inflammatory drugs (n = 14), oxytocin with or without frequent milk out (n = 5), biologics (n = 9), homeopathy (n = 5), botanicals (n = 4), probiotics (n = 2), and other alternative products (n = 2). All trials had at least one unclear or high risk of bias. Most trials (n = 13) did not observe significant differences in clinical or bacteriological cure rates in comparison with negative or positive controls. Few studies evaluated the effect of treatment on milk yield. In general, the power of the different studies was very low, thus precluding conclusions on noninferiority or nonsuperiority of the treatments investigated. No evidence-based recommendations could be given for the use of an alternative or non-antimicrobial conventional treatment for clinical mastitis. However, probiotics and oxytocin with or without frequent milk out should not be recommended. We concluded that homeopathic treatments are not efficient for management of clinical mastitis.
临床乳腺炎是奶牛场的一种重要疾病。其治疗主要基于使用抗菌药物。已经有许多非抗菌药物和治疗策略被报道用于治疗临床乳腺炎，但它们的疗效数据从未被系统地整理过。本系统评价的目的是确定除常规抗菌药物以外的治疗方法，用于治疗哺乳期奶牛的临床乳腺炎。通过对 1970 年 1 月至 2014 年 6 月期间从 CAB Abstracts、PubMed 和 Web of Science 中选择的英文或法文研究进行系统评价，筛选出了研究。保留了对照临床试验、观察性研究和实验性挑战。研究对象为患有临床乳腺炎的哺乳期奶牛。保留了哺乳期临床乳腺炎的所有除常规抗菌药物以外的治疗方法。仅纳入了比较研究治疗与阴性或阳性对照或两者的研究。评估的结果是临床和细菌学治愈率和产奶量。研究选择、数据提取和偏倚风险评估由 3 名评审员进行。干预措施系统评价的 Cochrane 协作工具用于评估偏倚风险。最初共确定了 2451 篇论文，其中 39 篇论文对应 41 项研究。其中，22 项为临床试验，18 项为实验研究，1 项为观察性研究。评估的治疗方法包括常规抗炎药物（n=14）、催产素联合或不联合频繁挤奶（n=5）、生物制剂（n=9）、顺势疗法（n=5）、植物药（n=4）、益生菌（n=2）和其他替代产品（n=2）。所有试验均至少存在一个不明确或高偏倚风险。大多数试验（n=13）在与阴性或阳性对照比较时，在临床或细菌学治愈率方面未观察到显著差异。很少有研究评估治疗对产奶量的影响。一般来说，不同研究的效力非常低，因此无法得出关于所研究治疗方法的非劣效性或非优越性的结论。对于临床乳腺炎的替代或非抗菌常规治疗，不能给出基于证据的推荐意见。然而，不建议使用益生菌和催产素联合或不联合频繁挤奶。我们的结论是，顺势疗法治疗对管理临床乳腺炎无效。
