Abstract
A systematic review and network meta-analysis were conducted to assess the relative efficacy of antimicrobial therapy for clinical mastitis in lactating dairy cattle. Controlled trials in lactating dairy cattle with natural disease exposure were eligible if they compared an antimicrobial treatment to a non-treated control, placebo, or a different antimicrobial, for the treatment of clinical mastitis, and assessed clinical or bacteriologic cure. Potential for bias was assessed using a modified Cochrane Risk of Bias 2.0 tool. From 14775 initially identified records, 54 trials were assessed as eligible. Networks were established for bacteriologic cure by bacterial species group, and clinical cure. Disparate networks among bacteriologic cures precluded meta-analysis. Network meta-analysis was conducted for trials assessing clinical cure, but lack of precision of point estimates resulted in wide credibility intervals for all treatments, with no definitive conclusions regarding relative efficacy. Consideration of network geometry can inform future research to increase the utility of current and previous work. Replication of intervention arms and consideration of connection to existing networks would improve the future ability to determine relative efficacy. Challenges in the evaluation of bias in primary research stemmed from a lack of reporting. Consideration of reporting guidelines would also improve the utility of future research.
Highlights
RationaleMastitis is one of the most costly diseases of dairy cattle (Halasa et al, 2007)
Clinical cure was reported in 33 trials, and 31 reported bacteriologic cure
As treatment of clinical mastitis reflects a large proportion of antimicrobial use in the dairy cattle industry, optimizing the use in this area can have a significant impact on overall Antimicrobial use (AMU)
Summary
Mastitis is one of the most costly diseases of dairy cattle (Halasa et al, 2007). It is painful, can result in premature culling, reduced milk production, and decreased fecundity at the cow level, and is often accompanied by herd-level consequences such as poor milk quality and increased risk of antimicrobial residues in marketed milk. In the United States, treatment for clinical mastitis represents the most common indication for antimicrobial use in adult dairy cattle, with 16.4% of cows reported as treated in 2007, with cephalosporins the most commonly selected drug class (United States Department of Agriculture, 2008). Dairy farmers and veterinarians have a considerable number of antimicrobial treatments available, including products of greater importance to human medicine. Veterinarians need information about the relative efficacy among products to facilitate their choices and, where possible, select efficacious products with the lowest human medical importance
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