Rationale for treatment of endometritis in the dairy cow

Endometritis is an inflammation of the uterine lining that is commonly initiated at parturition. The degree of its effect on fertility varies with the severity of the inflammation, the time required for resolution of endometrial lesions, and the extent of permanent changes that impair endometrial gland functions and/or alter the uterine and/or oviductal environment. The primary nonspecific organisms associated with endometrial pathology are Corynebacterium pyogenes and the gram-negative anaerobes. The majority of postpartum dairy cows have some degree of endometritis but resolve it by 40 to 50 days post partum. Cows with certain periparturient disorders involving the reproductive tract and/or a defective host immune mechanism may acquire persistent infections that impair subsequent fertility. Not all infertile cows or all cows with positive uterine cultures have endometritis. Cows recovering from C. pyogenes endometritis may require 1 month after clearance of the organism for fertility to be restored. These cows, as well as many cows with slightly delayed uterine involution at 30 days post partum, do not benefit from antimicrobial therapy. The effect of endometritis varies between herds. It is associated with prolongation of calving intervals that can vary from less than 2 weeks to 2 months or more. The cost of days open beyond 80 to 110 days post partum is currently estimated to be $2.00 to $2.25 per day. Evaluation of the bovine genital tract is best conducted by a rectal examination combined with a vaginal speculum examination. Cows selected for therapy for endometritis should meet the strict requirements of a grossly enlarged uterus and a severely abnormal uterine discharge. Induction of estrus is the treatment of choice whenever possible. When antimicrobial therapy is indicated, tetracycline is recommended for intrauterine use during the early postpartum period when mixed bacterial populations are present. Commonly used doses are 2 to 3 gm. For systemic signs of illness, systemic administration of penicillin has been recommended. Twice daily doses of 5000 to 10,000 IU of penicillin per kg may be necessary to maintain therapeutic blood concentrations. Systemic administration of an antimicrobial is necessary to achieve therapeutic concentrations in the oviducts, cervix, and vagina. With chronic endometritis due to C. pyogenes, intrauterine administration of 1 to 1.5 X 10(6) IU of procaine penicillin G has been recommended. Multiple daily treatments are desirable. Milk from treated cows should be tested for penicillin before it is added to bulk tank milk. It still is not clear whether antimicrobial therapy is cost effective.(ABSTRACT TRUNCATED AT 400 WORDS)