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Abstract :
[en] Mastitis is the most “antibiotic consuming” pathology in dairy medicine. Though antibiotics and antibiograms are known to vets since the early fifties, our practices did not evolved a lot from empiric antibiotic therapy. Indeed, the need for a treatment, the cost and the delay for an antibiogram are most of the time incoherent with a routine practice. Nevertheless, there is a surge for rational use of antibiotics. Our study was based on 1100 mastitis events from 30 Belgian farms collected between January 2011 and June 2012. We chose to compare tissular cure (TC) based on the threshold of 200.000 somatic cells/ml in milk at milk control at least 60 days after the clinical mastitis event. Regarding the mastitis event, severity (according 3 grades: alteration of milk as grade 1, alteration of quarter as grade 2 and alteration of general state as grade 3), quarter, treatments were recorded. We also assessed a chronicity status based on previous somatic cell count (SCC) of the cow. It was considered a new case a cow which at least 15 days before had an SCC <200.000 cells/ml, other were marked as chronic cases.
In our distribution, we see a seasonal rise of incidence between January and May. This period would represent twice as many mastitis as the summer period. Overall TC reaches 46% of all mastitis events, which is quite poor. Rear quarters had significantly lower TC (p<0,05%). Grade 3 mastitis had lower TC, 42,6% (p<0.05%) versus 48,9 % for grade 2 and 44,2% for grade 1. Almost 49% of all mastitis was considered as chronic cases, which TC was 33% on average, whereas new cases reached 55,3% TC. Study of treatment was frustrating given the high number of different combinations of treatments. It was underlined that 4th generation cephalosporins (C4G) were the most used in our cohort, followed by aminopenicillin/methicillin association (PENA/PENM) and 1st generation cephalosporins/aminoglycosids (C1G/AG) association. Of these intramammary treatments, 20% of the cases were submitted to a second intramammary drug, mostly C1G or C1G/AG. One third of the cases were treated parenterally with antimicrobials, mostly macrolids, fluoroquinolones and penethacillin. Finally, 10% of mastitis was treated with anti-inflammatory drugs, mostly tolfenamic acid and flunixin-meglumin.
Comparing mastitis without use of a secondary intramammary drug, only PENA and C1G/AG reached more than 60% TC. Considering new cases, then C1G/AG, PENA/PENM and Prednisolone containing specialties were above 60% TC. Use of a parenteral injections increased TC only on new cases (+12%), but not on chronic cases. Refining by severity, TC improved with a parenteral on new cases, mainly in grade 1 (+20%). Regarding associated factors, TC was negatively affected by chronicity, parity and lactation stage. Indeed, TC was lower on cases from more than 4 month in milk, third lactation (OR = 2.8 for no cure) compared with previous, and chronic cases (OR=2,6). Seemingly, chronicity was positively associated with parity and season. The 3rd parity cases had higher chances to be chronic ones (OR = 1,7), as well as cases from April to September (OR = 1,6).
This evaluation of cure is rather simple and has a good variability which allows several questions about the real match between antimicrobial treatment for mastitis and the udder inflammation. Based on our epidemiological data, we can modify routine management of mastitis, as some cases might not worth the antimicrobial treatment.
