4 Therapeutic Approach of Endometritis
Transcript
Happy to see you all in this session.
So far, we have seen the basics of the Types, Incidence, the Causative factors, and Pathogenesis of Endometriosis conditions. In the last session we have seen about the practical applicability, that is the Diagnosing the endometriosis condition and especially the sub-clinical endometritis which needs elaborate study and it’s very important also. Once we have Diagnosed the condition, we need a remedy, for that only we are going to see about the Therapeutic approaches for the endometritis conditions. Basically, we should know that there is a difference between the influences of Progesterone as well as the Oestradiol in the uterine environment. A high progesterone environment usually suppresses the uterine gland and cervical mucus secretions, myometrial contractility, the phagocytic activity of the uterine neutrophils but a high Oestrodiol content will increase the vascular porosity of the uterine lumen, promotes the migration of leukocytes and eosinophils, increase concentration of immunoglobulins, favors the physical clearance of inflammatory fluid. So basically, the progesterone environment will be a dry one and is high oestradiol will be a little bit more secretey in nature.
Progesterone influence thus is permissive to uterine infection on the contrary Oestrodiol environment facilitates the removal of microorganisms, this is a basic one for the Therapeutic approach.
We all know that Prostaglandin is one wonder drug, that can cut off the luteal phase by inducing luteolysis.
The benefit of PGF2 Alpha administration arises from the induction of oestrous in cows having a responsive corpus luteum, PGF2 Alpha will be very effective in inducing the estrous. The PG-induced oestrous leads to the physical expulsion of bacterial contaminants as well as inflammatory products.
PGF2 Alpha is not only a luteolytic activity but is also pro-inflammatory.
In that way, the PGF2 Alpha is one of the important agents in cleansing the uterine environment.
Uterine lavage is another technique, as we have already seen in the case of Diagnosing the sub-clinical Endometrium for the Cytological study, here we are going to see the same technique used as a Treatment, this can be again done the uterine lavage with a sterile normal saline solution, it’s a common treatment for the endometrial inflammation. Uterine lavage should be conducted for three consecutive days from the day of oestrus, in terms of cleansing the uterine environment. Uterine lavage can be done by infusing a sterile normal saline solution into the uterine body, using an intrauterine stainless-steel catheter, just by massaging the uterine lumen you can collect the fluid back, by back racking or by aspiration, so that the uterine environment is totally cleansed.
PGF2 Alpha treatment and Uterine Lavage favours the elimination of inflammatory products and induce uterine contractions that facilitate the evacuation of contaminants. Next comes the Antibiotic Therapy: this is also one of the important areas as well as a crucial area in the treatment of endometritis. There is a lot of chances for the development of antimicrobial resistance if you are going to use indiscriminate antibiotics, without any normal study. The Intrauterine Antibiotic Therapy is not indicated in clinical endometritis, why? the efficacy of these antibiotics in the local environment is diminished by the presence of pus and organic debris in the uterine fluid, as well as the oxygen-deficient atmosphere, which will also prevent the action of antibiotics. Again, most of the antibiotics are irritant to the uterine endometrium.
The systemic administration gives a better distribution in the tubular genital tract and eliminates the risk of damage to the endometrium. Broad-spectrum antibiotics such as oxytetracycline (in the dose rate of 22 milligram/kg body weight) will provide an effective minimal inhibitory concentration in the lumen and uterine tissues.
Systemic Streptopenicillin: is one of the simple basic antibiotics, which is having covered a wide range of infections. A Systemic Streptopenicilline (2.5 to 5 gram) total dose results in the genital tract tissue and lumen concentration, similar to that of the blood plasma concentrations.
Other anti-microbials such as metronidazole, ciprofloxacin, and cephalosporin are also administered effectively in the treatment of endometritis. Sub-clinical endometritis is again a special one, here intrauterine treatment of antibiotics can be followed because there is no pus or debris to affect the action of antibiotics and usually intrauterine fluoroquinolones just like Levofloxacin or Ofloxacin or Ciprofloxacin are found to be effective in the treatment of subclinical endometritis.
A combination of Levofloxacin or Ofloxacin + Ornidazole + alpha-tocopherol provides better recovery of uterine infections.
Levofloxacin or Ofloxacin is having a bactericidal action,
Ornidazole is having action against the anerobic bacteria,
Alpha-tocopherol is a powerful antioxidant, we have to see that there is a lot of oxidative stress at the time of endometritis and this alpha-tocopherol will take care of it again by an antioxidant action.
The next one is the Intrauterine Antiseptic Therapy and the most preferred one is a povidone[1]iodine that is the polyvinylpyrolidone- iodine is a broad-spectrum microbicide with the potency to inactivate bacteria, fungi, as well as protozoa, it’s a wide range of activity. A 2% povidone-iodine infusion into the uterus for three consecutive days from the estrous, will improve the fertility of the animal. What can be a successful approach? after seeing all these things, we have seen about the Antibiotics, Antiseptics and PGF2 Alpha, after seeing all these therapies, what is a successful approach? A Combo therapy, a combination of systemic antibiotics, we are not going for intrauterine antibiotics.
A combination of systemic antibiotic + intrauterine antiseptic + Hormone therapy that is PGF2 Alpha and sexual rest in the induced oestrous helps in successful conception in case of endometriosis condition, especially align of treatment can be suggested: Injection of streptopencillin 5 grams intramuscularly (5 gms; IM) along with a diluted Povidone-Iodine for three consecutive days from the day of estrous. Followed by Prostaglandin (PGF2 Alpha- Inj. Cloprostenol 500 micrograms/ Inj.Dinoprost tromethamine 25mg; IM) administration during the mid-luteal phase and an induced estrous will be there, you have to leave that estrous, give a sexual rest and then you can go for the breeding from the next cycle. This is one of the successful approaches for treating endometritis conditions in the case of cattle.
One more recent Treatment is being reported and still, it has not come into the field, but we have to know this because in the future Platelet Concentrate therapy (PC) will be enforced in many conditions, here the Platelet Concentrate enriches the uterine environment with factors necessary for embryo development and counteracts eventual sub-clinical endometritis by its anti-inflammatory properties. It has been reported that administration of Platelet Concentrate (PC) 10ml into the uterus of the animals at 48 hours after insemination, here we are going to breed the animal and then we are going to infuse the platelet by 48 hours after insemination, it produces encouraging results in case of repeat breeding animals. Yet a lot has to be studied using Platelet Concentrate therapy (PC) and it can be applied in the field condition in the near future.
One more alternative therapy we are going to have for the endometrial condition, any Uterine infections:
We are talking a lot about antimicrobial resistance nowadays, so indiscriminate usage of antibiotics leads to resistance conditions. We have a lot of literature that has been documented, ancient literature documenting with a lot of herbal therapy. So here we are going to have two important components of natural origin, that can be effective in treating the endometritis condition: – One is Radish (Raphanus sativus), it is going to have a very good anti-inflammatory activity because of its ‘raphanin’ content, that is having antibacterial activity, antifungal property and it’s also strongly active against the E-Coli. So Raphanus, that is radish is one of the important components in treating.
The next Cumin (Cuminum cyminum), this is having the volatile oil of this Cuminum cyminum /cumins is active against E-Coli Staphylococcus and other bacterial agents. We have already seen that E-Coli is one of the important uterine pathogens that is going to cause uterine infections, both these radish as well as the cumins are having an effect against the E-Coli and they are having a multifactorial effect on the antifungal and the antibacterial also.
How to apply:
A 10 gram of wet grounded Cumins can be smeared on the tongue of the animal, One piece of Raphanus sativus i.e., is Radish (150-200 g/day), it can be given, Both of them can be given orally for five days from the onset of estrous, and you can inseminate the animal or breed the animal in the next cycle and there are reports that there is about 85 percent recovery by giving this treatment. It can be tried in repeat breeding conditions where we can avoid the indiscriminate usage of antibiotics.
So, we have seen in this session, the various, Therapeutic approaches ranging from the PGF2 Alpha treatment, Uterine Lavage, Antibiotic treatment as well as the alternative treatment with the natural product of plant origin.
We have to decide as a veterinarian, as a clinician, we have to decide first the Degree of infection and based on the diagnosis you just decide, what is the line of treatment you want. As far as the antibiotics are concerned, it’s again one more concern is, you have to select an antibiotic based on the sensitivity in your area, in our experience Streptopenicillin is going to work very nicely, in most of the conditions. In the recent reports, we are seeing a lot of reports about the subtuophore but still, it can be decided by the veterinarians in that region by going for a sensitivity test in the lab. I hope you are now clear about the Therapeutic approaches for the endometritis condition in cattle.
See you all.
Thank you!
