Analyse de l'efficience des traitements de mammites de 50 fermes de Wallonie dans la base LAECEA

Analyse de l'efficience des traitements de

mammites de 50 fermes de Wallonie dans la

base LAECEA

1_{THERON L.,} 3_{REDING E.,} 2_{DETILLEUX J.,} 1_{RAO A.S.,} 3_{BERTOZZI C.,} 1_{HANZEN Ch.} 1_{Département clinique des animaux de production} 2_{Service de Génétique quantitative, Département des productions animales,} Faculté vétérinaire, Université de Liège, Belgique. 3_{Service recherche et développement, Association Wallonne de l’élevage. Ciney,} Belgique

Empirical antibiotherapy

• Antibiotics :

 1897 suspicion of “inhibition”

 1928 Flemming Penicilline

• Antibiograms :

 1944 beginning

 1950 formalisation

60 years… of probabilisation…

24/11/2013 3

Sustainable empirical Antibiotherapy

• Enhancement :

 Epidemiology/Herd medicine

 Probability based antibiotherapy

• Key performance indicators:

8) Which antibiotic is the

most indicated

for the

treatment of a severe mastitis?

1. Fluoroquinolones (marbo, enro, danofloxacine) 2. Aminopenicillins (Ampi, amoxicilline)

3. Polymyxins (colistine) 4. Trimethoprim-sulfamids 5. None

6. All

55 vétérinaires ruraux - Journées pluridisciplinaires UPV

9) Which antibiotic

do you use

the most for the

treatment of a severe mastitis??

1. Fluoroquinolones (marbo, enro, danofloxacine) 2. Aminopenicillins (Ampi, amoxicilline)

3. Polymyxins (colistine) 4. Trimethoprim-sulfamids 5. None

Mastitis encoding project

• Collaboration University of Liège – Walloon

Herd Association

 Research – Key production indexes

 Vet – Agro

• Encoding system and treatment recording

 Tactical document for the vet and the farmer

 Epidemiological analysis of udder health

Udder Health File

UHF : Recap

Cure in Dry-off

Material

• 50(70) farmers

 4200 cows (82/farms, 31-281)  8100 L on average(5800-12000)

Methods

• Animal factors

 Data DHI (Breed, NL, DIM, cells etc…)

• Mastitis factors

 Quarters atteined

 Severity

 Treatment

 Withdrawal time

Methods

• An indicator reccurent, strong and

frequent

 Individual somatic cell counts

• Cellular Cure =

SCC 30-60 days after

mastitis

• threshold 150 – 250.000 cell/ml

15

• «If there are no solution,

• Then there are no problem »

Project LAECEA : Mastitis Cohort

• >5000 mastitis recorded

Time Incidence

0 20 40 60 80 100 120 jan v

févr _mars avr mai juin juil _aoû

t se p t o ct n o v d é c jan v fé vr mar s avr _{mai ju}in 2011 2012 N o mb re d e c as c lin iq u e s

Incidence along production cycle

0 50 100 150 200 250 300 350 N u mb e r o f c ase s Days in milk 47,1% 42,6% 10,0% 0,3% 49% 38% 6% 3% 2% 1% 1%

Cellular variation analysis

• 51% = new cases

• 55% Cellular cure<60 jours

• 75% Cellular cure<120 jours • 25% High SCC after 5 months

• 49% = Chronic/High SCC cows

• 33% Cellular cure<60 jours • 44% Cellular cure<120 jours

• 56% High SCC after 5 months

• If a chronic case present a high SCC since >120 days before, odds for cure <25%

21

SEVERITY, QUARTER, WAY OF

ADMINISTRATION, MOLECULE

Study groups

Mastitis 2169 IMAM AB 2078 + Parenteral AB 849 + AI treatment 113 Parenteral AB 79 + AI treatment 15 AI Treatment 12

Intramammary treatment

0 50 100 150 200 250 300 1st _{intention intramammary} AG : Aminoglycosides PENA : Aminopenicillins PENM : Penicillin M MACR : Macrolids/Lincos 20 % of cases received a 2nd IMM. Mostly a C1G associated or not with AG

25

Parenteral treatment

0 20 40 60 80 100 120 140 160 180 200 Parenteral 1st _choice AG : Aminoglycosides PENA : Aminopenicillins PENM : Penicillin M MACR : Macrolids/Lincos PENET : Penethamate

Anti-inflammatory therapy

• N= 309 cases (15%)

27 0 20 40 60 80 100 120 140 Choice of AI therapy (N=309) 90 41 40 39 36 32 26 18 ₁₆ 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% NOCURE OK30

62 ₃₁ 28 27 21 19 19 8 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% NOCURE OK30

Cure rate : NEW+IMM once (N=393)

62 ₃₁ 28 27 21 19 19 8 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% NOCURE OK30

Cure rate: CHRO+IMM once

28 17 13 13 ₁₁ 10 ₇ 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% NOCURE OK30

Cure rate : NEW+P +/- IMM once

(N=500)

99 32 ₃₁ 29 _{24 15} 12 7 ₆ 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% NOCURE OK30

126 100 55 59 85 112 114 110 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Parenteral No parenteral Parenteral HSCC No parenteral HSCC

Efficacy of parenteral according to chronicity(N=761)

Cure No Cure

Combinations?

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

IMM IMM+P IMM+P+AI

Non guérison Guérison

Combinations of treatments

Combination _{Odds-ratio for}

_cure

p-value

IMM+AI 1,4 p<0,05

IMM+P 1,4 p<0,05

IMM+P+AI 2,0 p<0,05

IMM+P+AI on new cases 1,7 p<0,05 IMM+P+AI on chronic 2,4 p<0,05

Worst situation…

• 3

rd

_lactation

• 2

nd

_{half of lactation}

Sum-up

• Few NSAID

(too few?)

 However

enhancing AB association

• Efficacy over inflammation

 ~60% for new cases

 ~35% for chronic cases

• Parenteral treatment

 Enhance cure rate on acute cases

37

Résumé - SumUp

• Hypothesis?

 Streptococcus spectrum?

 Cell cure, efficient/real?

 Farm/cow effect?

• Consequences in prescription

 Define a

Chronic Class

 Define criterium for treatment

postposition

at dry-off

 Define criterium for

extended

treatment

think?

What

farmers

/society/professionnals

think?

think?

Most of the time they don’t need us

« Mastitis treatment can be seen as an archaism, with few new diagnosis methods, lots of new therapeutical medium and eventually very poor evaluation of the results » (Hillerton and Berry, 2005)