4 Treatment of Mastitis

Transcript

Hi Vets,

In the last lesson, we have seen about the Clinical signs of Mastitis and the Diagnosis of Mastitis. In this lesson, we will see about the Treatment Strategy, Antibiotic therapy, Antimicrobial resistance, and Non-antibiotic therapies.

The first one is Treatment Strategy; a veterinary needs to assess whether Antimicrobial therapy is needed for that particular case or that can be managed with supplements alone, considering the antimicrobial resistance and antimicrobial residues in the milk.

So normally there are recommendations that based on the clinical signs a vet can wait or can directly go for treatment. For example, if it is a change only with the milk and if the udder is normal, and if the cow is normal, it is recommended that a vet can wait for two days and by that time he can go for and if the rapid culture is negative, it can be left without any treatment which can result on its own and if there is any growth we have to go for particular treatment against that organism.

This holds good even with if there is any change in the milk and the udder, but if there is an abnormal cow we need not wait for any test results, we have to directly go for the administration of antibiotics and the supportive therapies.

Then after that which route is needed for administration, for example, if at least one quarter is affected the administration of the parent drug is not warranted, just administration of intra memory infusion will do. But if it is an abnormal cow we have to go for parental administration.

And the third strategy is the selection of antibiotics.

Actually, there are like two approaches-

one is based on the previous experience and the records that we have and

the other is going for the cultural result and the treatment according to that.

Actually, we cannot wait for two days in all the cases, so we need to go with our previous experience and the response to therapy may also differ from animal to animal and even the efficacy of Intra memory drug that we infuse into the udder may differ because of the presence of microabscesses or the presence of inflammation, the tissue protein binding, and the difference in the pH.

And we all know that the antibiotic sensitive may differ from place to place and season to season, so it is a big question whether we can wait for the result so it is better to go for treatment with our previous records of response and our previous results of the culture.

Then comes the fourth strategy; for how long, so it is normally recommended that we have to go for extended and aggressive therapy for seven to eight days, instead of the recommended two to three days. and the dose can also be a little bit higher than the recommended dose rate, but I doubt this may go for early onset of antimicrobial resistance, here I am presenting a table that indicates the pathogens and the relevant possible clinical signs and the relatively effective treatment.

So this is for your reference you can go through this table for a better understanding of the Clinical signs, related Pathogens, and the Treatment.

So far we have seen the Treatment of Lactating cows and the next one is the Dry cow therapy, which is very important in eliminating the existing Intra memory infections and preventing the occurrence of new Intra memory infections because I have been told that is a period when the occurrence of new Intra memory infections are common but the efficacy is going to be good if we treat the dry cows that is the dry cow therapy because there won’t be much of secretion during this period which may neutralize the efficacy of antibiotics.

So here again there are two types of treatments- one is Selective therapy and the other is Blanket therapy.

In Blanket therapy- we will be treating all the quarters or all the animals in the herd, whereas in Selective therapy- will be treating the affected teat or the affected animal. So normally we will be infused with long-acting intra memory antibiotic preparation preferably Cephalosporins but along with this if some internal heat sealant is utilized, the efficacy is going to be better the examples are Bismuth subnitrate and Chlorhexidine. So apart from this using a product from isella Siberia, which is a lactic acid bacterium useful as an internal teat sealant.

So apart from the usage of NSAIDs, supportive like intravenous fluids as in cases of Parachute and Acute cases, we have to infuse plenty of intravenous fluid even four to five liters of hypertonic saline can be given and immediate access to the drinking water should be given in such cases or isotonic fluids at the rate of 0.5 liters per minute can be administered with the help of Mcdougall needle, which helps in flushing out of the toxins and better dehydration.

Again there is a study that the usage of Oxytocin, at the dose of 10 to 20 international units, can help in flushing out the pathogens and also it helps in the migration of the neutrophils.

Even with this failure to treatment can happen, because of the presence of microabscesses especially increased cases of chronic Staphylococcus Mastitis and inefficient killing of the bacteria and internalization of the bacteria, which is not available for the drug to act, and due to increased antimicrobial resistance.

The last-mentioned antimicrobial resistance has gained its importance because most pathogens have gained multiple drug resistance, this can be due to unethical over usage of antimicrobials, extensive application of toxic chemicals, and the gut microbiome.

Actually, the concept of gut microbiota is contradictory in ruminants, but it is well established in the human beings that the microbiota of the gut, gets transferred to the mammary gland without any damage, which can lead to horizontal transmission of signaling even to the pathogens which will lead to the development of antimicrobial resistance to the pathogens and there is every possibility of mutation with every organism and again there is a risk of transfer of antimicrobial resistance from the human being to the animal strains.

One of the examples of this is Methicillin-resistant, Staphylococcus aureus, and the other minor reason is that there was a great gap in the invention of antimicrobials from 1970 to 2000. The treatment of Mastitis was started with the Sulfonamides in the 1930s and Pencilline in the 1940s and with other drugs and there was a gap of more than 30 years from 1970, where Quinolones were introduced to 2000.

Talking about the severity of antimicrobial resistance who has also released a list of critically resistant drugs against which new antimicrobials are to be developed, so that high priority is given to enterobacteria which include E-coli and Klebsiella, on the second high-risk bacteria are Staphylococcus aureus. So it is mentioned one thing that they are involved in Mastitis development in cattle.

So apart from Antibiotic therapy, Non-antibiotic therapy includes immunotherapy, nanoparticles, natural cytokines, herbal extracts, probiotics, laser radiation, lysozymes, propolis, and others. Even intra memory infusion of lactoferrin or ozone in addition to traditional medicine to manage antimicrobial resistance is successfully documented in 2019 by Malinowski.

So Immunotherapy can be done by the administration of microbeads, which contain specific antibodies against E-coli, Streptococcus, or Staphylococcus. And a single injection of interleukin 2 also provides resistance against most of the pathogens which causes Mastitis and infusion of extract of saccharomyces also increase the activity of the immune cells and again specific IgY from the egg yolk, is gives protection against E-coli and Staphylococcus aureus and it also increases the phagocytic activity.

And nowadays nanoparticles have gained importance in all the fields of science so here gold, and silver, nanoparticles are used in the treatment of Mastitis, their combination with antibiotics act as a synergistic and they increase the spectrum and the efficacy of the antibiotic which is administered.

The application of gold nanoparticles with honey is known to be highly antimicrobial against most pathogens, which cause Mastitis in bovines.

A combination of safety offers plus silver nanoparticles as Intra memory infusion has 99% efficacy over most of the pathogens which are causing Mastitis in bovines.

Nano Soya bean oil has also recorded its efficacy against some of the pathogens which cause Mastitis.

The next one is Photodynamic therapy; the principle is by the release of nascent oxygen and hydroxide, through sensitization of a nanoparticle such as safranine-O, here there is a selective killing and there is no development of antimicrobial resistance, which is an advantage of photodynamic therapy.

The next one is Acoustic pulse therapy; where the mechanical stimulus is converted into biochemical changes, which enhances the healing, and promotes the recovery even in affected animals.

The next one is Radiation therapy; here we use a low-intensity laser this enhances the regenerative capacity reduces pain and inflammation and also enhances the phagocytic activity.

The next is Stem cell therapy; here we use stromal stem cells of adipose tissue, they have antimicrobial properties, they have good regenerative properties, and they have angiogenesis, these are required for earlier recovery from the Mastitis.

The next one is the usage of Probiotics; Probiotics are nowadays commonly used in human Mastitis, they have a better effect than the usage of antibiotics, which are administered parentally or orally. But in ruminants, the study is only in the primary stage and better documentation or researchers are needed in this area.

The next one is Antimicrobial Peptides; actually, the antimicrobial peptides of a unicellular organism are like back resins whereas the antimicrobial peptides of multicellular organisms are defensins and cathelicidins, they also have good antimicrobial properties which will help in fighting against the Mastitis causing pathogens, but the limitations are they have a short half-life and the production cost is high and its efficacy is studied only in vitro and on the other hand they have a more cytotoxic effect.

The next one is Bacteriophage; they are very selective against the specific pathogens, injection of phage license, instead of this bacteriophages have a better effect and nowadays combination or cocktail of bacteriophages are being used instead of using single bacteriophage. The limitation is quicker development of antimicrobial resistance, snake venom of Bothrops are used, which is proved to disrupt the biofilm formed by Staphylococcus aureus.

If no treatment is effective, what next to do we use to dry that particular quarter? So for that 30- 60 ml of 3% silver nitrate can be infused or else 20 ml of 5% copper sulfate or 100-300 ml of 5% povidone-iodine 3 days continuous infusion of 60 ml of chlorhexidine can also be tried.

So this concludes lesson-4, so here we have seen ;

• The various Strategies of Treatment,
• Antimicrobial choice,
• The duration and the length of Treatment required,
• Usage of NSAIDs,
• Usage of Supportive therapy,
• Usage of Oxytocin and Non-antibiotic therapy

So in the next class, we will see about Alternative Therapy, Prevention, and Control of Mastitis.

Thank you!