Update on endometritis therapy

T. Katila
In: Pferdeheilkunde Equine Medicine · 2016 · vol. 32(1) , pp. 39–45 · doi:10.21836/pem20160107 · W2566096847
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Abstract

The corner stones of equine endometritis therapy are still antimicrobials and support of uterine evacuation. Ecbolic hormones, oxytocin and prostaglandins, and uterine lavage are the most commonly used treatments to increase uterine contractility and thereby uterine clearance. Prostaglandins are more long-acting than oxytocin and are therefore recommended in lymphatic stasis. Only non-irritant watersoluble antibiotics can be infused into the uterus. When deciding the route of administration -local or systemic -pharmacokinetic properties of antibiotics have to be taken into consideration. Chelating agents are recommended to increase the effect of antibiotics particularly in biofilm producing organisms. First generation Tris-EDTA is safe and non-irritant in the equine uterus. Third generation Tricide has been used in the treatment of equine endometritis in volumes 250 -500 ml. The drug binds to bacteria within minutes resulting in cell death and accumulation of debris, and therefore the uterus should be lavaged within 12 h to remove these by-products. The use of mucolytics has increased and kerosene and DMSO have been replaced by N-acetylcysteine (NAC). NAC removes inspissated secretions, exudate and biofilm and possesses antioxidant, anti-inflammatory and antimicrobial properties. Intrauterine treatment is well tolerated, but a lavage 4 -12 hours later is recommended. NAC-treatment has been shown to increase pregnancy rates in barren mares and in repeat breeders. Immunomodulators, corticosteroids and cell-wall extracts, are the recent additions to our toolkit. They seem to alter expression of cytokines in susceptible mares. Pregnancy rates are increased after a single dose of dexamethasone shortly before or at the time of mating in mares that accumulate intrauterine fluid during estrus. Platelet-rich-plasma is the newest therapeutic method but needs still more research. In experiments with a limited number of mares it was shown to down-regulate pro-inflammatory cytokines and inflammation and increase pregnancy rates in problem mares.

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