Randomized clinical trial of antibiotic and prostaglandin treatments for uterine health and reproductive performance in dairy cows

The objectives of this study were to assess the efficacy of antibiotic treatment for preventing postpartum uterine disease among cows at high risk of uterine disease, and to assess the efficacy of PGF(2α) for treating cytological endometritis (CYTO) and purulent vaginal discharge (PVD). A total of 2,178 Holstein cows in 6 herds were enrolled in a randomized clinical trial. Within 24h after parturition, cows were classified at being at high risk of uterine disease (HRUD; n=1,017) if they had twins, dystocia, or retained placenta. All remaining cows were classified as being at low risk of uterine disease (LRUD; n=1,161). Cows in the HRUD group were randomly allocated in a factorial design to receive ceftiofur crystalline free acid (CCFA) at 24h after parturition or be untreated, and to receive dinoprost (PGF(2α)) at 35 and 49 (±3) days in milk (DIM) or to be untreated. Cows in LRUD were randomly allocated to receive PGF(2α) at 35 and 49 (±3) DIM or to be untreated. Serum progesterone was measured at 21, 35, 49, and 63 (±3) DIM. Cows were examined at 35 (±3; exam 1) and 56 (±3; exam 2) DIM for CYTO (by cytobrush device; ≥6% polymorphonuclear cells in endometrial cytology) and for PVD (by Metricheck device; mucopurulent or purulent vaginal discharge). Statistical analyses were performed using multivariable logistic regression models accounting for herd clustering. Treatment with CCFA in HRUD cows was not associated with the probability of metritis overall, but interactions occurred such that CCFA decreased the incidence of metritis among HRUD cows that did not have retained placenta and among cows of parity ≥2. Treatment with CCFA in HRUD cows decreased the probability of PVD at exam 1. Treatment with PGF(2α) did not affect the probability of cure of CYTO or PVD irrespective of progesterone concentration at the time of treatment. Among cows affected by CYTO or PVD at exam 1, 66 and 63%, respectively, had spontaneously cured at exam 2. Cows persistently affected at exam 2 had an increased time to pregnancy and were more likely to have both CYTO and PVD at exam 1. Administration of PGF(2α) at both 5 and 7 wk postpartum did not mitigate the effects of CYTO or PVD on reproductive performance. Clinical approaches to treatment of chronic postpartum reproductive tract infection and inflammation should be reassessed.