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Fluid therapy in cows with toxic mastitis

Clinical Scenario

During a practice meeting you are discussing the treatment protocol for treating cows with toxic mastitis and nobody can agree. The issue of using intravenous fluids (hypertonic or isotonic) is particularly heated. You have only been in the practice 3 months and have only seen one cows with toxic mastitis but on EMS you have seen vets do a variety of things. You wonder if there is any evidence for the use of fluids in these cows......

3-Part Question (PICO)

In [dairy cattle with toxic E. coli mastitis] does [the administration of intravenous isotonic fluids in combination with NSAIDs compared to NSAIDs alone] [improve survival rate]?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

(cow.mp. OR cows.mp. OR cattle.mp. OR bovine.mp. OR bovines.mp. OR bos.mp. OR bovidae.mp. OR exp Cattle/)

AND

(mastitis.mp. OR E-coli.mp. OR Escherichia coli.mp. OR exp Mastitis/ OR exp Mastitis, Bovine/ OR exp Escherichia coli/)

AND

(iv fluids.mp.OR i v fluids.mp. OR intravenous fluid.mp. OR intravenous fluids.mp.OR fluid therapy.mp. OR exp Fluid Therapy/)

AND

(non steroidal anti inflammator$.mp. OR non steroidal antiinflammator$.mp. OR nonsteroidal anti inflammator$.mp. OR nonsteroidal antiinflammator$.mp. OR nsaid.mp. OR nsaids.mp. OR exp Anti-Inflammatory Agents, Non-Steroidal/)

CAB Abstracts 1910 to Present using the OVID interface

(cow.mp. OR cows.mp. OR cattle.mp. OR bovine.mp. OR bovines.mp. OR bos.mp. OR bovidae.mp. OR exp Cattle/)

AND

(mastitis.mp. OR E-coli.mp. OR Escherichia coli.mp. OR exp Mastitis/ OR exp Mastitis, Bovine/ OR exp Escherichia coli/)

AND

(iv fluids.mp.OR i v fluids.mp. OR intravenous fluid.mp. OR intravenous fluids.mp.OR fluid therapy.mp. OR exp Fluid Therapy/)

AND

(non steroidal anti inflammator$.mp. OR non steroidal antiinflammator$.mp. OR nonsteroidal anti inflammator$.mp. OR nonsteroidal antiinflammator$.mp. OR nsaid.mp. OR nsaids.mp. OR exp non-steroidal antiinflammatory agents/)

Search Outcome

MEDLINE

  • 3 papers found in MEDLINE search
  • 0 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 2 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from MEDLINE

CAB Abstracts

  • 22 papers found in CAB search
  • 18 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 3 papers excluded as they are review articles/in vitro research/conference proceedings
  • 1 total relevant papers from CAB

Total relevant papers

1 relevant papers from both MEDLINE and CAB Abstracts

Comments

One conference abstract appeared in the CAB search which contained the data which was eventually published in the paper included in the BET. This abstract was excluded from the BET as the same data can’t appear twice. This paper did not appear in the CAB search, although it was indexed by CAB, because it did not contain any terms pertaining to NSAIDs in the title, abstract or keywords and was not assigned to the “non-steroidal antiinflammatory agents” subject heading. However, its content would have been relevant.

Summary of Evidence

Green et al.1997, UK.

Title:

Comparison of fluid and flunixin meglumine therapy in combination and individually in the treatment of toxic mastitis.

Patient group:

Dairy cows with clinical signs consistent with toxic mastitis

Study Type:

Randomised controlled trial

Outcomes:

• Mortality
• Of the surviving cows, % returned to milk (RTM) versus culled for human consumption
• Bacteriological culture of affected and unaffected teats

Key Results:

• No significant difference in survival between the
groups (Fluid therapy + flunixin 10/18 survived versus flunixin alone 9/18 survived)
• No significant difference in outcomes in surviving cows (Fluid therapy + flunixin 7/10 RTM; flunixin alone 9/9 RTM)

Study Weaknesses:

• Small sample size (18 cows per treatment group) and no power/ sample size calculation
• No blinding
• Randomisation method unclear
• No clinical outcome measures beyond death/ RTM
• The i/v fluids used were unsterile tap water with added electrolytes, which could have had an adverse effect balancing out any putative treatment effect

Attachment:
No attachments.

Comments

This is a small study and without a power calculation/ sample size calculation, drawing conclusions for such numbers is problematic. There were also no outcomes based on the clinical picture of the cows, despite reasonably extensive initial assessment. Therefore it is only possible to draw conclusions based on survival/ return to milk, and not on clinical score following treatment, duration of illness, yield or future fertility, all of which would be relevant and useful. It should also be noted that the i/v fluids used in this study were an unlicensed, non-sterile combination of tap water and salts. Additionally, supportive therapy, including calcium, antimicrobial therapy and intramammary tubes were used in all cows.

Bottom line

The evidence found suggests that using intravenous isotonic fluids does not affect the likelihood of survival in cows with toxic mastitis. However, there was no evidence about any effect on clinical progression, time to recovery, welfare or yield.

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print

References

Comparison of fluid and flunixin meglumine therapy in combination and individually in the treatment of toxic mastitis. Green MJ. Green LE. Cripps PJ. Veterinary Record. 140(6):149-52, 1997 Feb 8.

About this BET

First author:
Jenny Stavisky
Second author:
Rachel Dean
Institution:

CEVM, University of Nottingham

Search last performed:
2018-08-01 10:11:38
Original publication date:
2013-09-13 10:11:38
Last updated:
2018-08-01 10:11:38
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