2011: Effective treatment of uterine disease in certified organic dairy herds


 

Effective treatment of uterine disease in certified organic dairy herds 
Gustavo M. Schuenemann,a Troy A. Brick,b Santiago Basa 

aDepartment of Veterinary Preventive Medicine and bDepartment of Veterinary Clinical Sciences, College 
of Veterinary Medicine, The Ohio State University, Columbus, OH 

 
Abstract 

Postpartum metritis and clinical endometritis are common uterine disorders in lactating dairy 
cows that negatively impact reproductive performance. For certified organic herds, implementation of 
preventive management practices such as proper nutrition and calving management are critical to prevent 
uterine diseases from occurring.  Several alternative therapies such as garlic tincture, aloe vera, vitamins, 
and vegetable oils have been used by organic dairy producers.  Despite the use of these alternative 
therapies to treat postpartum metritis, there is no scientific evidence available in the literature that can 
promote or discourage these practices.  For organic (and conventional) herds, the implementation of 
proactive management strategies that control the risk factors for uterine diseases should be a top priority. 
 
Keywords: Certified organic, dairy cattle, uterine diseases 
 
Introduction 

Organic food in the US, primarily produce and dairy products, reached retail sales over $21.1 
billion in 2008 and for several years, organic farmers struggled to produce enough supply to meet the 
growing domestic demand.1  The organic dairy industry has been growing steadily since 1990 not only in 
the US, but also in Europe.  The dairy sector has been one of the fastest growing segments of the organic 
commodities, almost doubling the number of certified milk cows every year between 1997 and 2005 in 
the US.1  Additionally, the retail demand for organic milk doubled and the retail milk prices were roughly 
double the conventional prices between 2004 and 2006.1  The 2005 US dairy survey showed that the size 
(small dairy operations) and location of the farm (Northeast and Upper Midwest) increased the likelihood 
of organic practices as an alternative to improve farm income.2,3  Environmental stewardship and milk 
price along with long term production contracts between the processors and producers have been the top 
reasons for converting to organic or adding a new organic dairy operation. 
 
Management practices for certified organic dairies 

Organic dairy production has gained increasing attention because of consumer concerns about 
food safety, animal welfare, and environmental impacts of intensive livestock operations.4  The National 
Organic Program (NOP) standards for dairy and livestock require that cattle are actively grazing and at 
least 30% of the total dry matter intake (on a daily basis) be provided from grazing pasture for a minimum 
of 120 days during the growing season (NOP access to pasture [livestock], February 12, 2010).  Although 
well managed pastures provide plentiful high quality forage, harvesting through grazing and balancing 
dairy rations present challenges.  Additionally, the US standard prohibits the use of antibiotic drugs and 
synthetic hormones in certified organic dairies.  If a lactating dairy cow is treated with prohibited 
substances (e.g., antibiotics), the organic status of the animal is lost.  It is important to note that from an 
animal welfare point of view, no animal must suffer and veterinary care should not be withheld to 
preserve the organic status of an animal.  The whole certified organic process relies on a number of 
preventive management practices such as nutrition management that ultimately assures cows’ health.  
Postpartum uterine diseases (e.g., retained fetal membranes, metritis), respiratory diseases, and mastitis 
require special attention.  An observational field study in Wisconsin revealed that the overall prevalence 
of mastitis, metritis, foot infections, and respiratory diseases was greater for conventional than organic 
dairy herds.5,6 
 
Risk factors for metritis and endometritis 

Postpartum metritis and clinical endometritis (CE) are common uterine disorders in lactating 
dairy cows that negatively impact reproductive performance; thus, diminishing profitability and 

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sustainability of dairy operations.  Metritis (puerperal; usually within 14 days postpartum) is defined as 
the inflammation of all layers of the uterus and characterized by fetid uterine discharge with fever, 
anorexia, and/or decreased milk production (systemically ill).7,8  Clinical endometritis is defined as the 
inflammation of the endometrial lining of the uterus characterized within 21-40 days in milk (DIM) by 
mucopurulent or more significant vaginal discharge (clinical diagnosis) or the presence of 
polymorphonuclear cells (≥5%, cytology diagnosis); usually without systemic signs of illness.  Lactating 
dairy cows subjected to poor nutrition management (body condition score at calving of <2.75; scale 1-5) 
increased the risk for uterine diseases with increased levels of non-esterified fatty acids and beta-
hydroxybutyrate in early postpartum cows.12  Furthermore, retained fetal membranes, stillbirths, 
abortions, dystocic births and twins12 as well as hygiene of the perineum region at calving (presence of 
manure and dirt around the birth canal) increased the likelihood of postpartum metritis and clinical 
endometrtis.9 
 
Management and treatment options for clinical endometritis 

Endometritis is an inflammation of the endometrial lining of the uterus without systemic signs of 
illness.7  Clinical endometritis negatively impacts reproductive performance (delays time to conception 
and increases the risk for culling after calving) in dairy cattle; thus, diminishing profitability and 
sustainability.7,10  A recent study in three herds showed that 18% of lactating dairy cows suffer from CE at 
35 DIM.12  Proactive management that targets the risk factors should be a top priority to prevent both 
puerperal metritis and CE.  For instance, cow comfort (e.g., 30 inches of feed bunk space and 80% 
stocking density in relation to stalls) during the pre- and postpartum period reduced the risk for uterine 
diseases such as metritis and CE. 

For clinical cases, administration of prostaglandin F2α analog (PG)12-14 and antimicrobial agents 
such as ceftiofur hydrochloride and penicillin7,15,16 are frequently used to treat these cows in conventional 
herds.  Antimicrobial therapy for cows with clinical signs of uterine disease is recommended in certified 
organic herds, but the organic status is lost and the animal must exit the herd.  Therefore, the use of 
alternative therapies such as garlic tincture, aloe vera, vitamins, and vegetable oils have been used by 
organic dairy producers.5,17  Despite the use of these alternative therapies to treat uterine diseases (e.g., 
metritis), there is no scientific evidence available in the literature that can promote or discourage these 
practices.  Recently, a field trial showed that homeopathic remedies (Lachesis compositum [Lachesis], 
Carduus compositum [Carduus], and Traumeel LT [Traumeel]) were not effective to prevent CE (based 
on clinical and fertility outcomes).18  The use of lytic enzyme preparations from Bacillus subtilis 
(Lysosubtilin) was assessed as alternative treatment for cows with postpartum endometritis compared to 
neofur or uterosan.19  Lysosubtilin (2 x 106 IU) was dissolved in 100 mL of distilled water and 
administered intrauterinarily twice per week until recovery in cows with CE as opposed to cows treated 
with neofur or uterosan.  This field trail showed that cows treated with a lytic enzyme preparation 
(Lysosubtilin) had improved therapeutic outcomes (clinical cure), reduced calving-to-conception interval, 
and improved conception risk compared to cows treated with neufur or uterosan. 

The use of intra-abdominal hypertonic glucose (20%) was previously reported to control acute 
peritonitis in rabbits.20  Furthermore, an in vitro study has shown that mannose (a sugar monomer) 
inhibits the adhesion of bacteria to the epithelial cells of the equine endometrium.21  This suggests that the 
use of 50% dextrose in water (a hypertonic solution), that targets the uterine environment rather than the 
bacterial pathogen itself, may be a viable and effective strategy for organic lactating dairy cows diagnosed 
with CE.  Recently, we investigated the use of intrauterine dextrose (200 mL; 50% dextrose in water) in a 
randomized clinical trail under field conditions.22  Lactating dairy cows (n=760) from two conventional 
herds were screened using vaginoscopy for CE at 26±3 DIM and scored using a 0-3 scale.8,23  Cows 
scored as 2 or 3 were stratified by parity and randomly allocated into one of three treatment groups: 1) 
control (n=83), 2) subcutaneous administration of ceftiofur crystalline free acid (CCFA, n=75; 6.6 mg/kg; 
Excede®; Pfizer Animal Health, New York, NY), or 3) intrauterine infusion (equine infusion pipettes) of 
200 mL 50% dextrose (n=79; Vedco, Saint Joseph, MO).  In this study, all cows (with or without CE) 
were presynchronized with two injections of PG given 14 days apart (starting at 26±3 DIM) followed by 

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Ovsynch (OV; gonadotropin releasing hormone [GnRH]-7 d-PG-56 h-GnRH 16 h-timed-artificial 
insemination [AI]) 12 days later.  This study showed that cows that received intrauterine dextrose had 
improved clinical cure compared to control groups.  Also, pregnancy per AI (PAI) in dextrose treated 
cows (29.8%) tended to differ (P=0.1) from cows in the control (21.1%) or CCFA treated groups (19.7%); 
whereas PAI in dextrose cows was not different from cows without CE (39.1%).22  It is important to note 
that intrauterine infusion is a procedure that requires proper training and strict aseptic precautions to 
prevent further uterine damage. 
 
Final remarks 

Postpartum metritis and CE are common uterine disorders in lactating dairy cows that negatively 
impact reproductive performance; thus, diminishing profitability and sustainability of dairy operations.  
For certified organic herds (as well as conventional herds), implementation of preventive management 
practices such as proper nutrition and calving management are key to prevent uterine diseases from 
occurring.  For clinical cases, the use of intrauterine dextrose showed promising clinical and fertility 
results.  However, further investigation is needed with certified organic herds to confirm and determine 
the underlying mechanisms for these findings. 
 
Acknowledgements 

The authors wish to thank the collaborating dairy farms for assisting and providing the animals 
used in the endometritis study.  Also appreciation is extended to Dr. J. Daniels and Dr. C. Pinto 
(Department of Veterinary Clinical Sciences) for their input and bacteriology analysis.  The effectiveness 
of the intrauterine dextrose administration on cows diagnosed with clinical endometritis was supported in 
part by the USDA-NIFA Animal Health (formula fund). 
 
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