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Endometritis

It is the inflammation of the endometrium. It is the most frequent cause of infertility in buffalo especially under field conditions. Incidence of endometritis is high in buffaloes 9.07-67.11%. The most important cause of endometrits is non specific opportunist pathogens that contaminate the uterus during the peri-parturient period. Other conditions are retention of placenta, abortion, dystocia, induction of parturition, genital prolapse, uterine inertia and traumatic lesions in the genital tract. Uterine function is often compromised in buffalo by bacterial contamination of the uterine lumen after parturition; pathogenic bacteria frequently persist, causing uterine disease, a key cause of infertility. It is called nonspecific infection because the initial colonizing bacterium is not known and the specific bacteria causing the signs of infection are not known, even though numerous bacteria in a variety of combinations have been isolated from infected uterus.

Incidence of Metritis/ Endometritis in buffaloes in different states

State

Incidence (%)

Haryana

8.69-11.32

UP

3.41

Maharashtra

12.45

                                Gujarat

28.72

Tamilnadu

6.33

Andhra Pradesh

18.73

Punjab

8.07

Madhya Pradesh

4.08

                                                                                                                                           (Khan et al. 2009)

Diagnosis of Endometritis/ Metritis on the basis of clinical manifestations and rectal examination is not reliable and hence we always treat with various drugs to cure infection and avoid repeat breeding. In general, the current therapies of Endometritis / Metritis and uterine infections, can be of following types:

Antibiotics

These have been widely used as treatment of uterine infections, but success of these treatments varies from beneficial to no benefit. When Penicillin is used, it may be inactivated through bacterial production of the enzyme Penicillinase. In case of Tetracyclines, the need of large systemic dose to get effective tissue concentration against A. pyogenes could be toxic to the animal.  The anaerobic environment of the uterus makes Aminoglycoside group (Gentamicin, Kanamicin, Streptomycin & Neomycin) ineffective because of the regular need of the oxygen for their activity. These antibiotics also inhibit phagocytosis. This suppression of leukocytic activity is further increased, if the bacteria are resistant to the antibiotic applied. In endometritis, the absorption of many drugs is diminished, due to which therapeutic levels in the deeper layers of the uterus and other parts of genital tract are not likely to be achieved. 

Penicillins are rapidly absorbed following intra uterine infusion, reaching peak plasma concentration in 1 h and decline below MIC after 4 h. Crystalline Penicillin G (1 million IU) & Procaine Penicillin (1 million IU) maintained detectable levels24 & 48 h, post-infusion respectively. Benzyl Penicillin following I/M route at 22000IU / kg body wt. peak levels in blood & endometrial tissue were attained 15 & 60 minutes post-administration, respectively and remained for longer periods of time.

Ampicillin: I/M @ 4-6 mg/kg bodyweight (b.w) need to be repeated at 24 h

Cephalexin: I/V 15 mg/kg b.w. needs to be repeated at 9 h.

Aminoglycosides: Dihydrostreptomycins attain peak 1-2 h following I/Ut. Intra-uterine dose is 1 gm. Detectable concentration remains for 24 h in uterine lumen.

Gentamicin: I/M administration @ 5mg/kg.

Tetracyclines: I/V twice daily@ 9-11 mg/kg b.w.

Chloramphenicol : Gives better results in uterine infection. I/M @ 20 mg/kg b.w. attains serum peak in 30 min. Needs to be repeated at 10 h in normal cycling & 12 h in dystocia  suffering animals.

Sulfonamides: Sulfonamides @ 80 mg/kg b.w. as loading dose and 65 mg/kg as maintenance dose provides antimicrobial cover to uterus up to 14 h.

Antiseptics

Weak or dilute Lugol’s Iodine solution has been an effective treatment of endometritis

Hormonal Therapy

·        Estrogens: They increase the uterine defense mechanism of reproductive tract by increasing the blood circulation, leukocyte infiltration to the uterus, uterine contractions, mucus flow and phagocytosis. Dose of Estradiol benzoate given I/M is small i.e. 5–6 mg. However, long acting estrogens and Stilbestrol have been associated with more severe infections of oviducts & myometrium and development of cystic ovaries.

·         Oxytocin: It increases phagocytosis. The effect can be seen upto 8 days post partum, if involution has been delayed.

·         Prostaglandin F analogues: It brings about luteolysis & decreases.

·        Progesteron induced inhibition of UDM and increases estrogen induced UDM. It has been observed that systemic use of antibiotics gives better results. Only a double dose of an antibiotic is required to achieve the optimum level of drug in the uterine lumen.

Other products

They are mainly based on substances which cause activation of uterine defense mechanism. These substances are E. coli endotoxins, Serum plasma & hyperimmune serum, Polymononuclear cells extracts and Component Granululocyte - Macrophage colony stimulating factor and 1-10 % Oyster glycogen.