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Formalin versus copper sulphate footbath for digital dermatitis in dairy cattle

Clinical Scenario

During a visit to one of your dairy herds, the owner Mr Jordan asks you for advice on his footbathing regime. Digital dermatitis (DD) is endemic in the herd, and he currently footbaths his cows three or four times per week through a solution of approximately 5% formalin. The farm's new herdsman is asthmatic and complains that handling the formalin exacerbates his condition. Additionally Mr Jordan has heard that formalin may be banned in the future because of its carcinogenic affects, so he asks how he would treat his cows if formalin becomes unavailable. Some of your other clients use copper sulphate footbaths rather than formalin and you wonder which is the most efficacious at reducing the clinical signs of digital dermatitis…

3-Part Question (PICO)

In [dairy cows with digital dermatitis] is [a formalin footbath compared to a copper sulphate footbath] more effective at [reducing the clinical signs of disease]?

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

AND

(digital dermatitis.mp. OR DD.mp. OR mortellaro.mp. OR dermatitis digitalis.mp. OR exp Digital Dermatitis/)

AND

(formalin.mp. OR formaldehyde.mp. OR exp Formaldehyde/ OR copper sulphate.mp. OR copper sulfate.mp. OR CuSO4.mp. OR footbath*.mp. OR foot bath*.mp. OR footdip*.mp. OR foot dip*.mp. OR exp Copper Sulfate/)

CAB Abstracts 1910 to Present using the OVID interface

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

AND

(digital dermatitis.mp. OR DD.mp. OR mortellaro.mp. OR dermatitis digitalis.mp.)

AND

(formalin.mp. OR formaldehyde.mp. OR exp Formaldehyde/ OR copper sulphate.mp. OR copper sulfate.mp. OR CuSO4.mp. OR footdip*.mp. OR foot dip*.mp. OR footbath*.mp. OR foot bath*.mp. OR exp copper sulfate/)

Search Outcome

MEDLINE

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

CAB Abstracts

  • 108 papers found in CAB search
  • 102 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
  • 2 total relevant papers from CAB

Total relevant papers

2 relevant papers from both MEDLINE and CAB Abstracts

Comments

A systematic review has been published on the use of copper sulphate footbaths. However, as it does not fully answer the PICO question for this BET, it has not been included. If you want to find out more, the reference is:

Thomsen, P. T. (2015). "Short communication: Efficacy of copper sulfate hoof baths against digital dermatitis—Where is the evidence?" Journal of Dairy Science 98(4): 2539-2544.

Summary of Evidence

Laven & Hunt (2002) UK

Title:

Evaluation of copper sulphate, formalin and peracetic acid in footbaths for the treatment of digital dermatitis in cattle.

Patient group:

Lactating Holstein dairy cows on a single farm

Study Type:

Randomised controlled trial

Outcomes:
  • Mean lesion score using a self-created scoring system on Day 0, 4, 7 and 21
  • Percentage of lesions present compared with Day 0 and other days of treatment
Key Results:
  • Significant reductions in lesion scores across time with all treatments; mean lesion score was significantly less on Day 7 and Day 21 when compared to Day 0
  • No statistically significant differences between treatments, or between treatments over time
  • No significant differences between treatments in the percentage of lesions remaining at any time
Study Weaknesses:
  • Aims not very specific
  • Not sure if randomisation is adequate
  • Unknown whether scoring system has been validated, and unknown how scores are calculated
  • Unknown whether outcomes were assessed blind
  • No sample size calculation carried out; they used cows on one farm only
  • Not known whether ethical approval was obtained
  • Not enough detail in methods for them to be repeated
  • It is unknown whether the groups were comparable prior to intervention
  • Missing animals were not accounted for
  • Negative findings were not really discussed
  • Results relate only to hindfeet
Attachment:
No attachments.

Holzhauer et al. (2012) The Netherlands

Title:

The effect of an acidified, ionized copper sulphate solution on digital dermatitis in dairy cows

Patient group:

Single commercial Holstein-Friesian herd - 110 cows

Study Type:

Randomised controlled trial

Outcomes:
  • Presence and severity of digital dermatitis lesions using a standardised published scoring system - statistical analysis focused only on presence or absence of ulcerative lesions (M2 classification)
  • Interdigital dermatitis
  • It states that there were other outcomes measured which were not reported in the study, e.g. heel erosion, other infectious and non-infectious lesions
Key Results:
  • At the end of the study, 3/106 copper sulphate treated cows had ulcerative lesions (M2 classification) on their hind claws compared with 14/106 formalin treated cows
  • It was stated that in relation to the survival analysis there was no significant difference in curative effects of ulcerative lesions in relation to the chlortetracycline spray between the two groups (Hazard ratio 1.5; P=0.23) - our interpretation of this is that there was no significant difference in curative effects of ulcerative lesions between the two groups
  • It was stated that in relation to the transitional logistic regression analysis there was no significant difference seen between two observations for cure rate for claws treated with copper sulphate or formalin
Study Weaknesses:
  • Single herd involved
  • Stated that all animals had been treated previously with formalin and copper sulphate prior to the study commencing, which could imply that cases may be more likely to be refractory towards the treatments tested in the study
  • Animals with ulcerative lesions were all treated with chlortetracycline spray in addition to footbathing - this makes it difficult to assess the true differences between the groups in relation to the interventions administered in the study
  • Not stated if outcomes or interventions were assessed or undertaken blind
  • No sample size justification was given
  • There was not a statistical significance level stated in the methods
  • Little comparison made between the two groups prior to the intervention being given - no information on age of animals, parity, milk yield etc.
  • It states that some animals were culled and new ones introduced across the study, but there is no information given as to how many were lost or gained between each time point
  • It was not stated whether any side effects of the intervention occurred
  • In the discussion the authors state that the cure rate of the ulcerative lesions were largely affected by the topical spray - the use of the topical spray introduces confounding to the study and limits the interpretation of the results in relation to cure rate
  • In the discussion the authors also claim that using each animal as its own control (i.e. administering both treatments on different hooves within the same animal) would bias the study towards not finding an effect if infections were clustered within animals
  • The study was funded by the manufacturers of the copper sulphate solution, but a conflict of interest statement outlines that the study was undertaken independently of the company
Attachment:
No attachments.

Comments

There were other papers found which could be of relevance (Logue et al. 2012), but it was not clear whether the preparations used were mixed compounds, or were the same as those in our BET.

The Holzhauer et al. (2012) paper used an acidified, ionized copper sulphate solution; it is unknown whether the copper sulphate solution in the Laven & Hunt (2002) paper was acidified and/or ionized.

Our outcome of interest focused on reducing the clinical signs of disease and not the prevention of lesion formation.

Comparisons with other footbathing products suitable for treating digital dermatitis would be useful topics for other BETs. 

Bottom line

There is insufficient evidence within these studies to conclude whether treatment of digital dermatitis with formalin or copper sulphate footbaths results in a superior reduction of clinical signs in dairy cows.

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

Laven RA, Hunt H (2002) Evaluation of copper sulphate, formalin and peracetic acid in footbaths for the treatment of digital dermatitis in cattle. Veterinary Record 151: 144-146.

Holzhauer M, Bartels CJ, Bergsten C, van Riet MMJ, Frankena K, Lam TJGM, (2012) The effect of an acidified, ionized copper sulphate solution on digital dermatitis in dairy cows. The Veterinary Journal 192: 659-663.

About this BET

First author:
Marnie Brennan
Second author:
Jenny Stavisky
Institution:

CEVM, University of Nottingham

Search last performed:
2016-06-14 16:34:11
Original publication date:
2014-05-30 16:34:11
Last updated:
2016-06-14 16:34:11
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