Aspekte einer evidenzbasierten Therapie klinischer Mastitiden

Abstract

Mastitis is one of the most common and expensive diseases in dairy cattle. The decision to treat clinical mastitis is usually made without any knowledge of the etiology, and can therefore only be evidence-based to a limited extent. Evidence-based medicine relies essentially on a combination of one's own clinical competence and scientific findings. In mastitis therapy, those insights depend mostly on pathogen-specific factors. Therefore, in evidence-based therapeutic decision making the pathogen identification should serve as a basis for the consideration of scientifically validated therapeutic concepts. The present paper considers evidence-based treatment of clinical mastitis based on a literature review. The authors conclude that an anti-inflammatory treatment using an NSAID should be conducted regardless of the pathogen. However, the choice of an antibiotic therapy depends on the mastitis causative pathogen, clinical symptoms and the animal itself. In principle, a local antibiotic treatment should be chosen for mild and moderate mastitis. It should be noted, that the benefit of an antibiotic therapy for coliform infections is questionable. With knowledge concerning the pathogen, it appears entirely reasonable to refrain from an antibiotic therapy. For severe (i. e. feverish) mastitis, a parenteral antibiotic therapy should be selected. An extension of the antibiotic therapy beyond the manufacturer's information is only reasonable for streptococcal infections. It is important to make the decision on a prolonged antibiotic therapy only with the knowledge of the mastitis-causative pathogen. In terms of the therapy of a staphylococcus or streptococcus infection, a narrow-spectrum antibiotic from the penicillin family should be adopted when selecting the active agents.

Bacteremia in Severe Mastitis of Dairy Cows

“…Antibiotics have become an integral part of mastitis therapy. Systemic antibiotic therapy is even recommended for severe mastitis cases because there is a risk of developing bacteremia [ 9 , 15 , 16 ]. Before answering the question about whether systemic antibiotics are necessary in severe mastitis, the prevalence and pathogenesis of bacteremia, as well as the effectiveness of systemic antibiotics must be clarified.…”

“…To treat severe mastitis and bacteremia, antibiotic therapy of mastitis appears to be unavoidable. In general, it is recommended to always treat severe mastitis parenterally with antibiotics because of the risk of bacteremia and the high risk of losing animals [ 9 , 14 , 15 , 16 ]. The effect of parenteral antibiotics in mastitis therapy is not only limited to the infected udder quarter, but also affects commensal bacteria throughout the body.…”

Status of udder health performance indicators and implementation of on farm monitoring on German dairy cow farms: results from a large scale cross-sectional study

“…In order to establish an effective standard protocol for the treatment of mastitis, it is first necessary to develop a system for the routine identification and analysis of clinical mastitis cases; this includes the microbiological examination of milk samples ( 61 ). Therefore, regular collection of quarter milk samples is highly desirable ( 62 ).…”

Comparison of the population structure of Streptococcus uberis mastitis isolates from Austrian small-scale dairy farms and a Slovakian large-scale farm

“…Strategies to decrease Strep. uberis prevalence in dairy herds include implementation of hygiene measures, enhancement of the immune status of cows, and pathogen-specific treatment concepts (Krömker et al, 2014;Ruegg, 2014;Mansion-de Vries et al, 2015). Risk assessment based on monitoring data (Samson et al, 2016;Soltau et al, 2017;Taponen et al, 2017), the implementation of novel diagnostic tools (Archer et al, 2017;Leimbach and Krömker, 2018), improved strain characterization (Hossain et al, 2015;Davies et al, 2016;Vélez et al, 2017;MLST, 2018c), and vaccination (Collado et al, 2018) are contributing to improved epidemiological understanding of Strep.…”