Therapeutic and Management options for Postpartum Metritis in Dairy Cattle

The treatment goal for postpartum metritis (e.g., endometritis, postpuerperal metritis, toxic puerperal metritis, pyometra) is to facilitate the timely clearance of the infection and return the animal to a normal reproductive state. Clinical signs associated with postpartum metritis range from temporary and self-limiting signs to chronic or life-threatening ones. Choosing an appropriate treatment for postpartum metritis depends on understanding the classification scheme for the disease. Treatment of cows with postpartum metritis generally involves hormonal and antibiotic therapy alone or in combination. Current efforts to promote prudent use of antibiotics have created renewed interest in the disease. Successful resolution of postpartum metritis can be accomplished by relying on the use of multiple diagnostic methods to accurately classify postpartum metritis, the incorporation of health-monitoring protocols for fresh cows to help prevent it, and the use of hormonal and antimicrobial therapy to help resolve it. Effective treatment of postpartum metritis (e.g., endometritis, postpuerperial metritis, toxic puerperal metritis, pyometra) in dairy cows remains a controversial topic. Monitoring programs for cows inmediately after parturition have aided in classifying postpartum metritis metritis, thereby facilitaring the development of preventive protocols and selection of appropriate therapy. Depending on the form of postpartum metritis diagnosed, there are several treatment options. Treatment of cows with postpartum metritis generally involves hormonal and antibiotic therapy alone or in combimation. Cattle suffering from less severe forms of postpartum metritis (e.g., endometritis, pyometra) are more likely to be treated with hormones, but many are also treated with antimicrobial agents. Clinical opinion varies on whether to treat cows with nontoxic metritis (e.g., endometritis, postpuerperal metritis). Clinical trials that evaluated agents, doses, routes of administration, and timing of nonantibiotic treatment in relation to days after parturition have given conflicting results. The apparent discrepancy in results can be attributed to such factors as clinical criteria used to diagnose metritis and performance measures that were evaluated. There is little argument that cows with toxic puerperal metritis showing signs of pyrexia, anorexia, dehydration, or shock should be minimally treated with antimicrobial drugs. Other types of treatment for these more seriously infected cattle include antiinflammatory agents, steroidal agents, and supportive agents (e.g., fluids). Cattle diagnosed with postpuerperal metritis or toxic puerperal metritis can be treated either with systemic antimicrobial agents or locally by intrauterine infusion of antimicrobial agents. This article discusses treatment options, including hormonal and antimicrobial therapy, for cows diagnosed with postpartum metritis. HORMONAL THERAPY The objective of hormonal therapy in resolving postpartum metritis is to induce estrous cycles, thereby increasing estrogen levels. Estrogen may affect the uterus in the following ways: • Stimulating uterine tone to aid in evacuating abnormal uterine contents • Increasing production of mucus that contains host defense compounds • Inducing estrus, which reduces progesterone levels, thereby markedly inhibiting neutrophil phagocytosis and resistance of the uterus to infection. Drug compounds, such as estrogens and prostaglandin F2a (PGF2a), have been incorporated into treatment protocols for cows suffering from postpartum metritis. The effect of these compounds on uterine motility and defense mechanisms makes them useful treatment alternatives to antimicrobial agents.