References
Selective treatment of clinical mastitis in dairy cows
Abstract
Over the last few years, the author, alongside many other dairy vets, has been working with dairy farmers to support them in carrying out selective dry cow therapy in their herds, while ensuring that cow health and welfare are not compromised. We can now have more informed discussions about the selective treatment of clinical mastitis in lactating dairy cows. This has been enabled by the recent advances and availability of cow-side pathogen testing, with several publications in the scientific literature evaluating farms carrying out selective treatment of clinical mastitis compared to blanket treatment, as well as the improved on-farm data we have around mastitis cases and mastitis patterns in our herds. The advantage of selective treatment is predominantly the reduced antibiotic use aligned with the One Health approach to the responsible use of antibiotics. There are other advantages to the selective treatment of cases, including targeted (narrow spectrum) antibiotic use and the increased farm focus and close monitoring of mastitis cases and cure rates on farm that come with reviewing mastitis treatment protocols. Vets can also be actively engaged in discussing the treatment and monitoring outcomes of mild and moderate cases of clinical mastitis, an area that has often been overlooked as a result of the focus on sick cows or toxic/severe cases requiring more involved and tailored therapy. Rapid and accurate cow-side pathogen tests allow selective treatment of clinical mastitis to be carried out on farm without compromising on treatment delay, so that the most effective treatment can be given to the appropriate mastitis cases. The focus of mastitis control must always remain on preventative measures to reduce the number of new infections. Through on-farm engagement with a wider mastitis discussion and creating bespoke tailored mastitis treatment programmes as part of selective treatment of clinical mastitis, this can serve as a regular reminder that prevention of new infections will always lead to the most significant benefits. This article reviews the available information on the selective treatment of clinical mastitis and presents some initial steps in data gathering and evaluation to ensure that the appropriate farms are undertaking selective treatment of mastitis cases.
The selective treatment of clinical mastitis is based on the now widely accepted evidence that the self-cure rate of many Gram-negative bacteria is high without the need for antibiotic therapy (Mansion-de Vries et al, 2016; Lago and Godden, 2018). This allows for more targeted treatment of Gram-positive bacteria, while it may be appropriate for Gram-negative bacteria to be treated without antibiotics. The recent advances and increasing availability of cow-side tests to differentiate between a Gram-positive and Gram-negative bacteria mean that this decision-making process can be based on a test result in conjunction with a wider risk assessment from a mastitis pattern analysis.
The principal benefit of carrying out selective treatment of clinical mastitis is in supporting the One Health approach to the responsible use of antibiotics through the reduction of antibiotic use and targeted antibiotic therapy. Pathogens that do not need antibiotic therapy to increase the likelihood of cure, primarily those with high self-cure rates such as some Gram-negative pathogens, do not receive antibiotic treatment. This will reduce the overall use of antibiotics on a unit, particularly where there is a high proportion of mastitis cases caused by Gram-negative bacteria. Cases that have Gram-positive bacteria identified can be treated with a targeted narrow spectrum antibiotic as part of the treatment plan. The narrow spectrum antibiotics for mastitis intramammary treatment all fall within the European Medicines Agency classification D (Table 1), for prudent use as first-line therapy wherever possible.
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