Treating Metritis

Phil Durst<durstp@msu.edu>, Mark Fox, Keith Sterner, Daniel Grooms, Michigan State University Extension - June 09, 2014

Metritis can reduce the reproductive and milking performance of fresh cows. It can be a costly disease and your first inclination from a hint of metritis may be to treat cows with an antibiotic. It’s time to review that inclination with your veterinarian.

Treatment of metritis may be the easy road, but it may not be the best road. Focus first on prevention of metritis. This article is the final in a series of four on metritis from Michigan State University Extension. Previous articles have discussed the causes, detection and prevention of metritis.

Every case of metritis is another reminder that changes need to be made well before freshening. While cases of metritis may need treatment, be judicious about treatment.

It is imperative that you work with the herd veterinarian who is responsible for drug use policy and protocols on your farm - the Veterinarian of Record (VOR). Work together and develop a diagnostic and treatment protocol for metritis. Make decisions together on courses of action based on levels of disease severity. The protocols should include diagnostic parameters (temperature, discharge, etc) and antimicrobials or other pharmaceutical products to be used including dose, route, and duration of therapy as well as the criteria for success or failure of therapy. Of course, important in this discussion is recognizing the milk and meat withholding times.

The cow was created to fight off infections and she may be able to do that on her own. However, elevated temperature is a warning flag that she should be watched to make sure that if she is infected, the infection is not overwhelming the ability of her immune response.

Elevated temperature alone is not an indication for treatment. Just because a fresh cow has an elevated temperature does not mean that she has metritis or should be treated. Dr. Sarah Wagner, North Dakota State University, examined fever, white blood cell counts and clinical signs during the first 10 days of lactation and concluded that rectal temperature has low specificity for diagnosing illness in postpartum dairy cows in the absence of other clinical signs.

Abnormal discharge alone is not an indication for treatment. Certainly, a foul-smelling reddish brown watery discharge is a sign of metritis. However, fresh cows may have an abnormal discharge in the postpartum period that is not metritis.

Treatment may be necessary when the cow is systemically sick. Train your employees to look for signs that the disease is systemic – that is, that the cow herself is sick and suffering. Systemic changes may include milk production decrease and visual signs that the cow is not feeling well including a raised tail, increased heart rate and reduced feed intake. These signs, in combination with elevated temperature or foul discharge, may indicate treatment.

There are several treatment options for metritis and endometritis. The selection of the best course of action depends on multiple factors. Work with your herd veterinarian in choosing the appropriate systemic antimicrobial therapy for your cows.

Uterine infusion with antibiotics may have, at one time, been the preferred treatment, however those infusions often do more harm than good. Bacteria may be introduced into the uterus during the process, uterine puncture can occur and tissue damage and subsequent scarring from the infusion itself may occur. In general, uterine infusion is not recommended.

Systemic antibiotics that are labeled for treatment of metritis have been shown to be effective for treating metritis. Regardless of what antimicrobial you choose, make sure you keep good records so that you and your veterinarian can evaluate treatment success and so that proper meat and milk with holding times are met

The use of prostaglandin F2 alpha and its analogs for metritis follow-up and endometritis later in lactation have been effective in helping the cow. The resulting estrus produces a uterine environment less conducive to the bacteria and stimulation of uterine contraction with expulsion of uterine exudates. Using prostaglandin to enhance cycling prior to the breeding window may be effective to prepare the uterus.

Supportive care for cows with severe metritis is also important. Oral and IV fluids for dehydrated cows and administration of non-steroidal anti-inflammatory drugs (NSAIDs) may improve the comfort and recovery of the cow.

One question producers may face is whether to move the treated cow to another pen. There are pros and cons of a move at this time. On the positive side, moving the treated cow to a sick cow pen may increase the opportunity for observation and it may be a pen with greater feed space and less competition. That needs to be balanced with the impact that moving her will have on dry matter intake. Dry matter intake may be the best medicine for metritis and needs to be encouraged rather than discouraged.

Treatment, while it may be a legitimate response, should not be the first thought in response to a sick cow. Take time to evaluate your metritis prevention, detection and treatment protocols. Work with your management team to reduce the incidence of uterine disease in your herd. The improvement in production and reproductive success will be your reward.