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Enrofloxacin in dairy cattle with E. coli mastitis

Clinical Scenario

You have attended a clinical governance meeting at your practice about the use of antibiotics. The farm animal partners are keen to streamline the use of antibiotics in the dairy side of the business. Toxic mastitis was used as an example where the use of antibiotics could be standardised between vets, however an argument then broke out about if you should use antibiotics at all in these cases. Most people seemed to agree that NSAIDs were beneficial but questioned the use of antibiotics. You routinely use enrofloxacin in these cases (as that is what you were taught) along with an NSAID but now you wonder if that is necessary...

3-Part Question (PICO)

In [dairy cattle with E. coli mastitis] does [the administration of enrofloxacin in combination with NSAIDs compared to NSAIDs alone] [improve clinical recovery]?

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 exp cattle/)

AND

(e coli mastitis.mp. OR escherichia coli mastitis.mp. OR coliform mastitis.mp. OR toxic mastitis.mp. OR systemic mastitis.mp. OR exp Mastitis, Bovine/ OR exp Escherichia coli/)

AND

(enrofloxacin.mp. OR baytril.mp. OR fluoroquinolone.mp. OR fluoroquinolones.mp. OR exp Fluoroquinolones/)

AND

(NSAID.mp. OR NSAIDs.mp. OR non steroidal.mp. OR nonsteroidal.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 exp cattle/ OR exp cows/)

AND

(e coli mastitis.mp. OR escherichia coli mastitis.mp. OR coliform mastitis.mp. OR toxic mastitis.mp. OR systemic mastitis.mp. OR exp bovine mastitis/)

AND

(enrofloxacin.mp. OR baytril.mp. OR fluoroquinolone.mp. OR fluoroquinolones.mp. OR exp fluoroquinolone antibiotics/ OR exp enrofloxacin/)

AND

(NSAID.mp. OR NSAIDs.mp. OR non steroidal.mp. OR nonsteroidal.mp. OR exp non-steroidal antiinflammatory agents/)

Search Outcome

MEDLINE

  • 4 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
  • 1 papers excluded as they are review articles/in vitro research/conference proceedings
  • 3 total relevant papers from MEDLINE

CAB Abstracts

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

Total relevant papers

3 relevant papers from both MEDLINE and CAB Abstracts

Comments

Two of the three relevant papers contain data from the same study so the most appropriate of the two is included in the BET.

The paper that is not included is: Hirvonen et al (1999) Acute phase response in dairy cows with experimentally induced Escherichia coli mastitis. Acta vet Scand 40: 35-46.

Summary of Evidence

Suojala L, 2010, Finland

Title:

Efficacy of enrofloxacin in the treatment of naturally occurring, acute clinical Escherichia coli mastitis

Patient group:

Lactating dairy cows (Finnish Ayrshire or Holstein Friesian breeds) with naturally occurring E. coli mastitis (N = 132)

Study Type:

Randomised controlled trial

Outcomes:
  • Clinical cure (at 2 and 21 days) - clinical cure defined as no systemic signs, a normal udder and normal milk appearance
  • Bacteriological cure (at 2 and 21 days)
  • Return to milk production of the affected quarter (at 21 days)
  • Survival in the herd - assessed as remaining in the herd for 3 weeks post treatment and also recorded if the cows remained in the herd 6 months later
Key Results:
  • The clinical cure rate on day 2 was significantly lower in the enrofloxacin group (n=64) compared to the non-treated group (n = 68). (8.1% of cows in the enrofloxacin group showed clinical cure compared to 20% in the non treated group, p = 0.016)
  • There was no significant difference in clinical cure rate on day 21 between the 2 treatment groups (46.7% in the enrofloxacin group versus 57.1% in the non treated group)
  • Bacteriological cure rates were significantly higher in the enrofloxacin group on day 2 (Odds ratio for cure = 3.32, p = 0.002)
  • Bacteriological cure rates on day 21 were similar in the two treatment groups (90.5% in the enrofloxacin group and 86.8% in the non treated group)
  • Survival rates of cows at day 21 or survival in the herd at 6 months did not differ between the 2 treatment groups
  • Quarter milk production returned in 21.8% of cows in the enrofloxacin group and 37.3%  of the untreated cows
Study Weaknesses:
  • Randomisation method used (odd and even cow ID numbers) was predictable and therefore open to bias
  • No blinding was used in the study
  • Differing supportive therapies available to each cow e.g. frequent milking, fluid therapy. Unclear whether the uptake of these therapies was significantly different between treatment groups
  • Some assessments subjective e.g. estimated quarter milk production
  • Reliant on owner compliance for second dose of enrofloxacin administration and some outcome measurements
  • Reasons for all cases excluded not described, and unclear whether the withdrawals/exclusions were balanced across the treatment groups
  • Large amounts of missing data
  • No sample size calculation performed before data collection
Attachment:
No attachments.

Rantala et al, 2002, England

Title:

Efficacy and pharmacokinetics of enrofloxacin and flunixin meglumine for treatment of cows with experimentally induced Escherichia coli mastitis.

Patient group:

 Finnish Ayrshire cows with experimentally induced E.coli mastitis (N=6)

Study Type:

Randomised controlled trial (cross over design)

Outcomes:
  • Systemic and local clinical signs
  • Daily milk yield
  • Pharmacokinetic parameters e.g. serum and milk concentrations of enrofloxacin
Key Results:
  • No significant differences in clinical signs between the two treatment groups
  • No statistically significant differences in the number of deaths between the two treatment groups (p = 0.27)
  • Cows receiving enrofloxacin plus NSAID compared to NSAID alone produced 0.9 litres more milk per day during the study (p <0.05)
Study Weaknesses:
  • Mastitis was experimentally induced
  • Cows varied in their severity of clinical signs - only 3 had moderate to severe clinical signs.
  • Method of randomisation not described
  • No blinding used
  • No sample size calculation and very small number of cows in the study
  • Insufficient description of clinical sign scoring systems used
  • Limited presentation of data and statistical analyses
  • No statistical significance level stated
Attachment:
No attachments.

Comments

Suojala et al. is a larger, field-based clinical trial which is more representative of the patients likely to be seen in clinical practice compared to the smaller, experimentally induced E. coli mastitis trial of Rantala et al. However the methodological weaknesses of the Suojala et al. study mean that interpretation and application of the results is difficult. The 2 studies used different NSAIDs  - flunixin in Rantala et al. and ketoprofen in Suojala et al. Further high quality trials would be beneficial to address this question.

Bottom line

The evidence found does not support the use of enrofloxacin to improve clinical recovery in dairy cattle with E. coli mastitis.

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

L. Suojala, H. Simojoki, K. Mustonen, L. Kaartinen, S. Pyörälä, (2010). Efficacy of enrofloxacin in the treatment of naturally occurring acute clinical Escherichia coli mastitis. Journal of Dairy Science 93 (5):1960-1969.

Rantala, M. , Kaartinen, L. , Välimäki, E. , Stryrman, M. , Hiekkaranta, M. , Niemi, A. , Saari, L. and Pyörälä, , (2002). Efficacy and pharmacokinetics of enrofloxacin and flunixin meglumine for treatment of cows with experimentally induced Escherichia coli mastitis. Journal of Veterinary Pharmacology and Therapeutics  25 (4): 251–258.

About this BET

First author:
Kathryn Wareham
Second author:
Rachel Dean
Institution:

CEVM, University of Nottingham

Search last performed:
2015-09-07 09:06:38
Original publication date:
2015-11-27 09:06:38
Last updated:
2015-11-27 09:06:38
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