A mixed treatment comparison meta-analysis of antibiotic treatments for bovine respiratory disease

Antimicrobial Activities of α-Helix and β-Sheet Peptides against the Major Bovine Respiratory Disease Agent, Mannheimia haemolytica

Bovine respiratory disease (BRD) is the leading cause of morbidity and mortality in cattle raised in North America. At the feedlot, cattle are subject to metaphylactic treatment with macrolides to prevent BRD, a practice that may promote antimicrobial resistance and has resulted in an urgent need for novel strategies. Mannheimia haemolytica is one of the major bacterial agents of BRD. The inhibitory effects of two amphipathic, α-helical (PRW4, WRL3) and one β-sheet (WK2) antimicrobial peptides were evaluated against multidrug-resistant (MDR) M. haemolytica isolated from Alberta feedlots. WK2 was not cytotoxic against bovine turbinate (BT) cells by the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. All three peptides inhibited M. haemolytica, with WK2 being the most efficacious against multiple isolates. At 8-16 µg/mL, WK2 was bactericidal against Mh 330 in broth, and at 32 µg/mL in the presence of BT cells, it reduced the population by 3 logs CFU/mL without causing cytotoxic effects. The membrane integrity of Mh 330 was examined using NPN (1-N-phenylnaphthylamine) and ONPG (o-Nitrophenyl β-D-galactopyranoside), with both the inner and outer membranes being compromised. Thus, WK2 may be a viable alternative to the use of macrolides as part of BRD prevention and treatment strategies.

Using information from network meta-analyses to optimize the power and sample allocation of a subsequent trial with a new treatment

BACKGROUND

A critical step in trial design is determining the sample size and sample allocation to ensure the proposed study has sufficient power to test the hypothesis of interest: superiority, equivalence, or non-inferiority. When data are available from prior trials and leveraged with the new trial to answer the scientific questions, the value of society's investment in prior research is increased. When prior information is available, the trial design including the sample size and allocation should be adapted accordingly, yet the current approach to trial design does not utilize such information. Ensuring we maximize the value of prior research is essential as there are always constraints on resources, either physical or financial, and designing a trial with adequate power can be a challenge.

METHODS

We propose an approach to increasing the power of a new trial by incorporating evidence from a network meta-analysis into the new trial design and analysis. We illustrate the methodology through an example network meta-analysis, where the goal is to identify the optimal allocation ratio for the new three-arm trial, which involves the reference treatment, the new treatment, and the negative control. The primary goal of the new trial is to show that the new treatment is non-inferior to the reference treatment. It may also be of interest to know if the new treatment is superior to the negative control. We propose an optimal treatment allocation strategy which is derived from minimizing the standard error of the log odds ratio estimate of the comparison of interest. We conducted a simulation study to assess the proposed methods to design a new trial while borrowing information from the existing network meta-analysis and compare it to even allocation methods.

RESULTS

Using mathematical derivation and simulations, we document that our proposed approach can borrow information from a network meta-analysis to modify the treatment allocation ratio and increase the power of the new trial given a fixed total sample size or to reduce the total sample size needed to reach a desired power.

CONCLUSIONS

When prior evidence about the hypotheses of interest is available, the traditional equal allocation strategy is not the most powerful approach anymore. Our proposed methodology can improve the power of trial design, reduce the cost of trials, and maximize the utility of prior investments in research.

Comparison of two distinct arrival and treatment programs for bovine respiratory disease in high-risk feeder cattle entering a feedlot

Antimicrobial metaphylaxis of high-risk cattle entering the feedlot is a common management strategy implemented against bovine respiratory disease (BRD). Typically, following a prescribed postmetaphylactic interval (PMI), animals displaying clinical signs of BRD are pulled from the feedlot pen and treated with antimicrobials when treatment criteria are met. The objective of this study was to compare 2 distinct sequential BRD treatment protocols each consisting of a metaphylactic antimicrobial plus 2 potential subsequent as-needed treatment antimicrobials. Heifers at high-risk for BRD (n = 1000; initial BW = 229 kg ± 1.6) purchased from sale barns in the southeastern U.S. were transported to a contract research feedlot in Nebraska and randomly assigned to 1 of 2 experimental groups (10 blocks of 100 animals each; 50 per treatment group). Experimental groups consisted of: (1) tulathromycin metaphylaxis (2.5 mg/kg) followed by ceftiofur crystalline free acid (6.6 mg/kg) and danofloxacin (8 mg/kg) for subsequent first and second as-needed BRD treatment, respectively (TCD) or (2) tildipirosin metaphylaxis (4 mg/kg) followed by florfenicol-flunixin meglumine (40 mg/kg florfenicol; 2.2 mg/kg flunixin meglumine) and enrofloxacin (12.5 mg/kg) for subsequent first and second as-needed BRD treatment, respectively (TFFE). Following expiration of the 7-d PMI, calves that showed signs of clinical BRD were pulled and examined to determine if treatment was necessary based on a clinical attitude score (CAS). Heifers with a CAS of 1 accompanied by ≥40°C rectal temperature, and all heifers with a CAS ≥ 2 regardless of rectal temperature, received the appropriate first-treatment antimicrobial. Upon relapse, following expiration of the post-treatment interval (PTI), heifers received the appropriate second-treatment antimicrobial. In the first 90 d, calves in the TFFE experimental group received more first-treatments than calves in the TCD experimental group (P = 0.054) and resulted in 50% greater mortality (P < 0.043) relative to the TCD heifers. From d 0 to closeout, first-treatment morbidity as well as mortality were greater in TFFE relative to TCD (P ≤ 0.032). Growth performance did not differ between treatments in the first 90 d; however, ADG was greater (P = 0.033) and G:F improved (P = 0.014) at closeout in TCD versus TFFE on a deads-in basis. Closeout economics revealed a $50.78/animal greater profit in the TCD experimental group relative to TFFE.

Bovine Respiratory Disease Considerations in Young Dairy Calves

Raising young dairy calves presents many challenges for producers and veterinarians including losses attributable to BRD. This article will discuss several key concepts for practitioners to consider when applying evidence-based medicine for the control and treatment of BRD in young dairy calves. The authors review BRD complex, provide considerations for diagnostic approaches, and discuss research associated with the control and treatment of BRD.

Relative Efficacy of Dry-Off Antimicrobial Treatments in Dairy Cattle to Cure Existing Intramammary Infections: A Systematic Review and Network Meta-Analysis

This systematic review and network meta-analysis aimed to estimate the relative efficacy of dry cow antimicrobial therapies, registered in Canada and/or the United States, to cure existing intramammary infections (IMI) in dairy cattle. The controlled trials examining all-cause cures of existing IMI present at dry-off were eligible. Five databases and four conference proceeding platforms were searched. The risk of bias at the level of the outcome was assessed using the Cochrane 2.0 risk of bias instrument (Cochrane, Denmark), and the overall confidence in the findings from the network meta-analysis was assessed using the Confidence in Network Meta-Analysis (CINeMA) platform. Of 3,743 articles screened for eligibility by the two independent reviewers, 58 trials were included in the Bayesian network meta-analysis for the all-cause cure of existing IMI from dry-off to calving. No antimicrobial treatment (non-active control) was associated with a decreased risk of a cure compared with all other currently labeled antimicrobials in Canada and the United States; however, lack of replication trials for some antimicrobial products created large credibility intervals and, therefore, we were unable to identify meaningful comparisons between the products. Poor reporting of trial features, heterogeneity in outcome measurements, and high risk of bias in some domains further contributed to this inability to compare antimicrobials. Continued improvement in the reporting of animal trials is required to make recommendations for antimicrobial products on the basis of efficacy.

Systematic Review Registration:https://atrium.lib.uoguelph.ca/xmlui/bitstream/handle/10214/16236/Protocol_NMA_efficacy_dryoff_antibiotics_cure_IMI.pdf?sequence=3&amp;isAllowed=y.

Treatment of bovine respiratory disease with a single administration of tulathromycin and ketoprofen

BACKGROUND

The therapeutic strategy of bovine respiratory disease (BRD) often involves a combination of an antibiotic with an anti-inflammatory agent. Aim of this study was to evaluate the clinical effect of a new combination product containing tulathromycin and ketoprofen for the treatment of naturally occurring BRD.

METHODS

Two hundred and eighty animals were randomized upon diagnosis of BRD. One hundred forty animals each were treated once subcutaneously with tulathromycin-ketoprofen or tulathromycin. Rectal temperature of each animal was measured at 1, 2, 4, 6, 8, 10, 12 and 24 h post-treatment. Individual respiration and depression scores were determined at 6 h post-treatment. Daily rectal temperature, respiration and depression scores were recorded from day 2 to 14 and on day 21.

RESULTS

The tulathromycin-ketoprofen and tulathromycin treatment group demonstrated a treatment success rate of 94.2% and 95.0%, respectively and a relapse rate of 3.8% and 4.0%, respectively. Tulathromycin-ketoprofen demonstrated superior pyrexia control compared to tulathromycin within the first 24 h following treatment. Tulathromycin-ketoprofen-treated animals demonstrated faster improvement of their clinical symptoms (respiration and depression score).

CONCLUSION

Efficacy of tulathromycin-ketoprofen for the treatment of BRD was non-inferior to tulathromycin. The combination product clearly exhibited more pronounced fever control than tulathromycin which is considered beneficial for animal welfare.

Economic impact of digital dermatitis, foot rot, and bovine respiratory disease in feedlot cattle

Digital dermatitis (DD) has emerged in North American feedlots, although production and economic impacts are not fully understood. Objectives of this study were to: (1) estimate the economic impact of a single case of DD, foot rot (FR), and bovine respiratory disease (BRD) in feedlot cattle and (2) determine its impact on average daily gain (ADG). Feedlot cattle health and production records were available from two feedlots for a 3-yr interval. The dataset consisted of 77,115 animal records, with 19.3% (14,900) diagnosed with a disease. Diseased animals were categorized into five groups: DD, FR, BRD, other diseases (OT), and two or more diseases (TM), with a treatment cumulative incidence of 6.0%, 59.1%, 10.7%, 12.7%, and 11.5%, respectively. FR was the disease with the highest cumulative incidence in both heifers and steers (58.8% and 59.6%, respectively). Of all fall-placed cattle diagnosed with any disease, 48.1% of the cases were FR. DD affected the partial budget in five out of the eight groups of cattle, with the highest impact of DD seen in grass yearling heifers and grass yearling steers: $-98 and $-96 CAD, respectively, relative to their healthier counterparts. Healthy cattle had a significantly higher ADG when compared with DD cattle in five of the eight categories, ranging from 0.11 kg/d in winter-placed heifers to 0.17 kg/d in fall-placed steers. In the economic analysis, it was concluded that on an individual animal basis, BRD was the most impactful of all analyzed diseases, whereas DD was second, marking the importance of controlling and mitigating this foot condition. Identifying differential effects of diseases on a partial budget analysis and ADG of the types of cattle stratified by sex enables feedlot producers to focus control and mitigation strategies on specific groups.

Economic effects of policy options restricting antimicrobial use for high risk cattle placed in U.S. feedlots

The rising public health threat of antimicrobial resistance, the influence of food service companies, as well as the overall lack of positive image of using medical products in intensive farming are major drivers curbing antimicrobial use. In the future, government policies may affect practices of antimicrobial use in beef production in feedlots, a prominent current user of antimicrobials in animal agriculture, but also the agricultural industry generating the highest cash receipt in the U.S. Our objective was to estimate the cost effect from the following policies in feedlots: 1) using antimicrobials for disease prevention, control, and treatment; 2) using antimicrobials only for treatment of disease; and 3) not using antimicrobials for any reason. We modelled a typical U.S. feedlot, where high risk cattle may be afflicted by diseases requiring antimicrobial therapy, namely respiratory diseases, liver abscesses and lameness. We calculated the net revenue loss under each policy of antimicrobial use restriction. With moderate disease incidence, the median net revenue loss was $66 and $96 per animal entering the feedlot, for not using antimicrobials for disease prevention and control, or not using any antimicrobials, respectively, compared to using antimicrobials for disease prevention, control, and treatment. Losses arose mainly from an increase of fatality and morbidity rates, almost doubling for respiratory diseases in the case of antimicrobial use restrictions. In the case of antimicrobial use prohibition, decreasing the feeder cattle price by 9%, or alternatively, increasing the slaughter cattle price by 6.3%, would offset the net revenue losses for the feedlot operator. If no alternatives to antimicrobial therapy for prevention, control and treatment of current infectious diseases are implemented, policies that economically incentivize adoption of non-antimicrobial prevention and control strategies for infectious diseases would be necessary to maintain animal welfare and the profitability of beef production while simultaneously curbing antimicrobial use.

Association between antimicrobial drug class selection for treatment and retreatment of bovine respiratory disease and health, performance, and carcass quality outcomes in feedlot cattle

Treatment and control of bovine respiratory disease (BRD) is predicated on the use of two categories of antimicrobials, namely bacteriostatic drugs that inhibit bacterial growth and replication (STATIC), and bactericidal drugs that kill bacteria in in vitro culture systems (CIDAL). Recently, we reported that initial BRD treatment with a STATIC antimicrobial followed by retreatment with a CIDAL antimicrobial was associated with a higher frequency of multidrug-resistant bacteria isolated from field cases of BRD submitted to a veterinary diagnostic laboratory. The present study was conducted to test the hypothesis that calves administered the same class of antimicrobial for first and second BRD treatment (i.e., CIDAL-CIDAL or STATIC-STATIC) would have improved health and performance outcomes at the feedlot compared to calves that received a different antimicrobial class for retreatment (i.e., STATIC-CIDAL or CIDAL-STATIC). The association between antimicrobial treatments and health, performance, and carcass quality outcomes were determined by a retrospective analysis of 4,252 BRD treatment records from a commercial feedlot operation collected from 2001 to 2005. Data were compared using generalized linear mixed statistical models that included gender, season, and arrival weight as covariates. The mean (±SE) probability of BRD cases identified as requiring four or more treatments compared to three treatments was greater in calves that received STATIC-CIDAL (73.58 ± 2.38%) or STATIC-STATIC (71.32 ± 2.52%) first and second antimicrobial treatments compared to calves receiving CIDAL-CIDAL (50.35 ± 3.46%) first and second treatments (P < 0.001). Calves receiving CIDAL-CIDAL first and second treatments also had an increased average daily gain (1.11 ± 0.03 kg/d) compared to calves receiving STATIC-CIDAL (0.95 ± 0.03 kg/d) and STATIC-STATIC (0.84 ± 0.02 kg/d) treatments (P < 0.001). Furthermore, CIDAL-CIDAL-treated calves had a higher probability of a choice quality grade at slaughter (36.44 ± 4.80%) compared to STATIC-CIDAL calves (28.09 ± 3.88%) (P = 0.037). There was no effect of antimicrobial treatment combination on BRD mortality (P = 0.855) or yield grade (P = 0.240) outcomes. These observations suggest that consideration should be given to antimicrobial pharmacodynamics when selecting drugs for retreatment of BRD. These findings have implications for developing BRD treatment protocols that address both post-treatment production and antimicrobial stewardship concerns.

Efficacy of bacterial vaccines to prevent respiratory disease in swine: a systematic review and network meta-analysis

A systematic review and network meta-analysis (MA) was conducted to address the question, 'What is the efficacy of bacterial vaccines to prevent respiratory disease in swine?' Four electronic databases and the grey literature were searched to identify clinical trials in healthy swine where at least one intervention arm was a commercially available vaccine for one or more bacterial pathogens associated with respiratory disease in swine, including Mycoplasma hyopneumoniae, Actinobacillus pleuropneumonia, Actinobacillus suis, Bordetella bronchiseptica, Pasteurella multocida, Stretococcus suis, Haemophils parasuis, and Mycoplasma hyorhinis. To be eligible, trials had to measure at least one of the following outcomes: incidence of clinical morbidity, mortality, lung lesions, or total antibiotic use. There were 179 eligible trials identified in 146 publications. Network MA was undertaken for morbidity, mortality, and the presence or absence of non-specific lung lesions. However, there was not a sufficient body of research evaluating the same interventions and outcomes to allow a meaningful synthesis of the comparative efficacy of the vaccines. To build this body of research, additional rigor in trial design and analysis, and detailed reporting of trial methods and results are warranted.

The efficacy of litter management strategies to prevent morbidity and mortality in broiler chickens: a systematic review and network meta-analysis

A systematic review and network meta-analysis (NMA) were conducted to address the question, 'What is the efficacy of litter management strategies to reduce morbidity, mortality, condemnation at slaughter, or total antibiotic use in broilers?' Eligible studies were clinical trials published in English evaluating the efficacy of litter management in broilers on morbidity, condemnations at slaughter, mortality, or total antibiotic use. Multiple databases and two conference proceedings were searched for relevant literature. After relevance screening and data extraction, there were 50 trials evaluating litter type, 22 trials evaluating litter additives, 10 trials comparing fresh to re-used litter, and six trials evaluating floor type. NMAs were conducted for mortality (61 trials) and for the presence or absence of footpad lesions (15 trials). There were no differences in mortality among the litter types, floor types, or additives. For footpad lesions, peat moss appeared beneficial compared to straw, based on a small number of comparisons. In a pairwise meta-analysis, there was no association between fresh versus used litter on the risk of mortality, although there was considerable heterogeneity among studies (I2 = 66%). There was poor reporting of key design features in many studies, and analyses rarely accounted for non-independence of observations within flocks.

Comparative efficacy of antimicrobial treatments in dairy cows at dry-off to prevent new intramammary infections during the dry period or clinical mastitis during early lactation: a systematic review and network meta-analysis

A systematic review and network meta-analysis were conducted to assess the relative efficacy of antimicrobial therapy given to dairy cows at dry-off. Eligible studies were controlled trials assessing the use of antimicrobials compared to no treatment or an alternative treatment, and assessed one or more of the following outcomes: incidence of intramammary infection (IMI) at calving, incidence of IMI during the first 30 days in milk (DIM), or incidence of clinical mastitis during the first 30 DIM. Databases and conference proceedings were searched for relevant articles. The potential for bias was assessed using the Cochrane Risk of Bias 2.0 algorithm. From 3480 initially identified records, 45 trials had data extracted for one or more outcomes. Network meta-analysis was conducted for IMI at calving. The use of cephalosporins, cloxacillin, or penicillin with aminoglycoside significantly reduced the risk of new IMI at calving compared to non-treated controls (cephalosporins, RR = 0.37, 95% CI 0.23-0.65; cloxacillin, RR = 0.55, 95% CI 0.38-0.79; penicillin with aminoglycoside, RR = 0.42, 95% CI 0.26-0.72). Synthesis revealed challenges with a comparability of outcomes, replication of interventions, definitions of outcomes, and quality of reporting. The use of reporting guidelines, replication among interventions, and standardization of outcome definitions would increase the utility of primary research in this area.

A systematic review and network meta-analysis of injectable antibiotic options for the control of bovine respiratory disease in the first 45 days post arrival at the feedlot

We conducted a systematic review and network meta-analysis to determine the comparative efficacy of antibiotics used to control bovine respiratory disease (BRD) in beef cattle on feedlots. The information sources for the review were: MEDLINE®, MEDLINE In-Process and MEDLINE® Daily, AGRICOLA, Epub Ahead of Print, Cambridge Agricultural and Biological Index, Science Citation Index, Conference Proceedings Citation Index - Science, the Proceedings of the American Association of Bovine Practitioners, World Buiatrics Conference, and the United States Food and Drug Administration Freedom of Information New Animal Drug Applications summaries. The eligible population was weaned beef cattle raised in intensive systems. The interventions of interest were injectable antibiotics used at the time the cattle arrived at the feedlot. The outcome of interest was the diagnosis of BRD within 45 days of arrival at the feedlot. The network meta-analysis included data from 46 studies and 167 study arms identified in the review. The results suggest that macrolides are the most effective antibiotics for the reduction of BRD incidence. Injectable oxytetracycline effectively controlled BRD compared with no antibiotics; however, it was less effective than macrolide treatment. Because oxytetracycline is already commonly used to prevent, control, and treat BRD in groups of feedlot cattle, the use of injectable oxytetracycline for BRD control might have advantages from an antibiotic stewardship perspective.

A systematic review and network meta-analysis of bacterial and viral vaccines, administered at or near arrival at the feedlot, for control of bovine respiratory disease in beef cattle

Vaccination against putative causal organisms is a frequently used and preferred approach to controlling bovine respiratory disease complex (BRD) because it reduces the need for antibiotic use. Because approximately 90% of feedlots use and 90% of beef cattle receive vaccines in the USA, information about their comparative efficacy would be useful for selecting a vaccine. We conducted a systematic review and network meta-analysis of studies assessing the comparative efficacy of vaccines to control BRD when administered to beef cattle at or near their arrival at the feedlot. We searched MEDLINE, MEDLINE In-Process, MEDLINE Daily Epub Ahead of Print, AGRICOLA, Cambridge Agricultural and Biological Index, Science Citation Index, and Conference Proceedings Citation Index - Science and hand-searched the conference proceedings of the American Association of Bovine Practitioners and World Buiatrics Congress. We found 53 studies that reported BRD morbidity within 45 days of feedlot arrival. The largest connected network of studies, which involved 17 vaccine protocols from 14 studies, was included in the meta-analysis. Consistent with previous reviews, we found little compelling evidence that vaccines used at or near arrival at the feedlot reduce the incidence of BRD diagnosis.

Comparative efficacy of teat sealants given prepartum for prevention of intramammary infections and clinical mastitis: a systematic review and network meta-analysis

A systematic review and network meta-analysis were conducted to assess the relative efficacy of internal or external teat sealants given at dry-off in dairy cattle. Controlled trials were eligible if they assessed the use of internal or external teat sealants, with or without concurrent antimicrobial therapy, compared to no treatment or an alternative treatment, and measured one or more of the following outcomes: incidence of intramammary infection (IMI) at calving, IMI during the first 30 days in milk (DIM), or clinical mastitis during the first 30 DIM. Risk of bias was based on the Cochrane Risk of Bias 2.0 tool with modified signaling questions. From 2280 initially identified records, 32 trials had data extracted for one or more outcomes. Network meta-analysis was conducted for IMI at calving. Use of an internal teat sealant (bismuth subnitrate) significantly reduced the risk of new IMI at calving compared to non-treated controls (RR = 0.36, 95% CI 0.25-0.72). For comparisons between antimicrobial and teat sealant groups, concerns regarding precision were seen. Synthesis of the primary research identified important challenges related to the comparability of outcomes, replication and connection of interventions, and quality of reporting of study conduct.

Comparative efficacy of antimicrobials for treatment of clinical mastitis in lactating dairy cattle: a systematic review and network meta-analysis

A systematic review and network meta-analysis were conducted to assess the relative efficacy of antimicrobial therapy for clinical mastitis in lactating dairy cattle. Controlled trials in lactating dairy cattle with natural disease exposure were eligible if they compared an antimicrobial treatment to a non-treated control, placebo, or a different antimicrobial, for the treatment of clinical mastitis, and assessed clinical or bacteriologic cure. Potential for bias was assessed using a modified Cochrane Risk of Bias 2.0 tool. From 14775 initially identified records, 54 trials were assessed as eligible. Networks were established for bacteriologic cure by bacterial species group, and clinical cure. Disparate networks among bacteriologic cures precluded meta-analysis. Network meta-analysis was conducted for trials assessing clinical cure, but lack of precision of point estimates resulted in wide credibility intervals for all treatments, with no definitive conclusions regarding relative efficacy. Consideration of network geometry can inform future research to increase the utility of current and previous work. Replication of intervention arms and consideration of connection to existing networks would improve the future ability to determine relative efficacy. Challenges in the evaluation of bias in primary research stemmed from a lack of reporting. Consideration of reporting guidelines would also improve the utility of future research.

How to Conduct a Bayesian Network Meta-Analysis

Network meta-analysis is a general approach to integrate the results of multiple studies in which multiple treatments are compared, often in a pairwise manner. In this tutorial, we illustrate the procedures for conducting a network meta-analysis for binary outcomes data in the Bayesian framework using example data. Our goal is to describe the workflow of such an analysis and to explain how to generate informative results such as ranking plots and treatment risk posterior distribution plots. The R code used to conduct a network meta-analysis in the Bayesian setting is provided at GitHub.

Net return distributions when metaphylaxis is used to control bovine respiratory disease in high health-risk cattle

This study’s objective was to estimate net returns and return risk for antimicrobial metaphylaxis options to manage bovine respiratory disease (BRD) in high health-risk feedlot cattle. The effectiveness of antimicrobials for metaphylaxis varies by cattle population. How differing antimicrobial effectiveness translates to net return profitability for heterogeneous cattle populations is less understood. Net returns and return risk were assessed using a net return simulation model adapted to allow for heterogeneity in high health-risk cattle placement characteristics and antimicrobial choice to control BRD. The net return model incorporated how antimicrobials modify BRD health and performance outcomes. Health and performance outcomes were calibrated from published literature and proprietary feedlot data. Proprietary data came from 10 Midwestern feedlots representing nearly 6 million animals and 50,000 cohorts. Twelve placement-by-metaphylaxis decision combinations were assessed: high health-risk steer placement demographics were 600 or 800 lb steers placed in Winter (Oct–Mar) or Summer (Apr–Sept) managed with one of three different health programs: “no metaphylaxis,” “Upper Tier” antimicrobial, or “Lower Tier” antimicrobial. Net return distributions were compared between “no metaphylaxis” and a specific antimicrobial tier within specific cattle populations. We found the expected incremental net return of administering an “Upper Tier” (“Lower Tier”) antimicrobial for metaphylaxis compared to “no metaphylaxis” for high health-risk steers was $122.55 per head ($65.72) for 600 lb and $148.65 per head ($79.65) for 800 lb winter placements. The incremental expected net return and risk mitigated by metaphylaxis varied by placement weight, season, and antimicrobial choice. The probability net returns would decline by at least $50 per head was significantly reduced (from approximately 4% to 40%) when any antimicrobial was used on high health-risk steers. Both tiers of antimicrobials used for metaphylaxis increased expected net returns and decreased net return variability relative to no metaphylaxis. Thus, feedlots were more certain and realize a greater profit on high health-risk pens of steers when metaphylaxis was used. This occurred because the reduction in cattle health and performance outcomes using any antimicrobial was sufficiently large to cover added initial and subsequent antimicrobial costs. Results aid in assessing metaphylaxis strategies in high health-risk cattle.

Whole blood transcriptomic analysis of beef cattle at arrival identifies potential predictive molecules and mechanisms that indicate animals that naturally resist bovine respiratory disease

Bovine respiratory disease (BRD) is a multifactorial disease complex and the leading infectious disease in post-weaned beef cattle. Clinical manifestations of BRD are recognized in beef calves within a high-risk setting, commonly associated with weaning, shipping, and novel feeding and housing environments. However, the understanding of complex host immune interactions and genomic mechanisms involved in BRD susceptibility remain elusive. Utilizing high-throughput RNA-sequencing, we contrasted the at-arrival blood transcriptomes of 6 beef cattle that ultimately developed BRD against 5 beef cattle that remained healthy within the same herd, differentiating BRD diagnosis from production metadata and treatment records. We identified 135 differentially expressed genes (DEGs) using the differential gene expression tools edgeR and DESeq2. Thirty-six of the DEGs shared between these two analysis platforms were prioritized for investigation of their relevance to infectious disease resistance using WebGestalt, STRING, and Reactome. Biological processes related to inflammatory response, immunological defense, lipoxin metabolism, and macrophage function were identified. Production of specialized pro-resolvin mediators (SPMs) and endogenous metabolism of angiotensinogen were increased in animals that resisted BRD. Protein-protein interaction modeling of gene products with significantly higher expression in cattle that naturally acquire BRD identified molecular processes involving microbial killing. Accordingly, identification of DEGs in whole blood at arrival revealed a clear distinction between calves that went on to develop BRD and those that resisted BRD. These results provide novel insight into host immune factors that are present at the time of arrival that confer protection from BRD.

Treatment of congenital extrahepatic portosystemic shunts in dogs: A systematic review and meta-analysis

Background

Several options have been proposed for the treatment of congenital extrahepatic portosystemic shunts (cEHPSS) in dogs, but formal comparisons among different treatment options are currently unavailable. A previous evidence‐based review (2012) found low quality of evidence for papers assessing the treatment of cEHPSS in dogs.

Objectives

To assess the quality of evidence available in the treatment of cEHPSS, summarize the current state of knowledge with respect to outcome after cEHPSS management, and compare different treatment techniques.

Animals

Not used.

Methods

A bibliographic search was performed without date or language restrictions. Studies were assessed for quality of evidence (study design, study group sizes, subject enrollment quality, and overall risk of bias) and outcome measures reported (perioperative outcome, clinical outcome, and surgical or interventional outcome), all reported with 95% confidence intervals. A network meta‐analysis was performed.

Results

Forty‐eight studies were included. Six retrospective studies (grade 4b) compared 2 techniques and 7 were abstracts (grade 5). The quality of evidence was low and risk of bias high. Regarding surgical outcome, statistically significant superiority of ameroid constrictor over thin film band was observed (P = .003). No other comparisons were statistically significant.

Conclusions and Clinical Importance

The evidence base of choice of treatment of cEHPSS in dogs remains weak despite recent publications on the subject. Ameroid is superior to thin film band in causing EHPSS closure. Blinded randomized studies comparing different treatment modalities, which routinely include postoperative imaging to assess cEHPSS closure and acquired portosystemic shunt development are essential.

Antimicrobial Policies in United States Beef Production: Choosing the Right Instruments to Reduce Antimicrobial Use and Resistance Under Structural and Market Constraints

Antimicrobial use (AMU) in animal agriculture contributes to the selection of resistant bacteria, potentially constituting a public health threat. To address antimicrobial resistance, public policies set by governments, as well as intra-sectoral approaches, can be implemented. In this paper, we explore how common policy instruments such as regulations, economic incentives, and voluntary agreements could help reduce AMU in beef production. We first describe the structure of the beef supply chain which directly influences the choice of policy instruments. We describe how externalities and imperfect information affect this system. We then discuss how five policy instruments would each perform to achieve a reduction in AMU. Bovine respiratory disease complex (BRD) represents the major driver of AMU in beef production; consequently, reducing its incidence would decrease significantly the amounts of antimicrobials administered. We consider control options for BRD at different stages of the beef supply chain.

Implementing Precision Antimicrobial Therapy for the Treatment of Bovine Respiratory Disease: Current Limitations and Perspectives

The therapeutic efficacy of an early treatment protocol with an infection-stage adjusted fluoroquinolone regimen was evaluated in a field study on young bulls (YBs) presenting signs of bovine respiratory disease (BRD). A total of 195 YB (Charolais, Limousin, and Rouge-des-Prés breeds) from 6 farms implementing or not prophylactic antimicrobial treatments (PROPHY or absence) were randomly assigned to 1 of 2 experiment groups based on time of detection of BRD and first-line marbofloxacin regimen, early adjusted dose [Early 2 (E2)] or late standard dose [Late 10 (L10)]. Each YB was administered orally a reticulo-rumen bolus, allowing continuous monitoring of ruminal temperature. In the E2 group, YB presenting early signs of BRD, i.e., an increase in ruminal temperature over 40.2°C and persisting more than 12 h, confirmed by a clinical examination showing no or mild signs of BRD, were given 2 mg/kg of marbofloxacin. In the L10 group, YBs presenting moderate or severe signs of BRD at visual inspection, confirmed at clinical examination, were given 10 mg/kg of marbofloxacin. If needed, YBs were given a relapse treatment. The YBs were followed for 30 days. The proportions of first and relapse treatments were calculated, as well as the therapeutic efficacy at day 10. In the E2 group, the first-line treatments’ proportion was significantly higher (P < 0.05), while the relapse treatments’ proportion tended to be higher (P = 0.08), than in the L10 group. Evolution of clinical scores (CSs) of diseased YB was followed for 10 days. In both groups, CS and rectal temperature decreased significantly 24 h after treatment (P < 0.05). Treatment incidences (TI) representing antimicrobial consumption assessed on used daily doses (UDD) were calculated. Antimicrobial consumption of marbofloxacin and relapse treatments were not significantly different between the groups. These values were strongly influenced by the recourse to a prophylactic antimicrobial treatment, accounting for more than 90% of the antimicrobial amount in the herds implementing prophylaxis. The higher number of treatments in the groups treated on the basis of ruminal temperature monitoring, the accuracy of the detection method, and the necessary conditions to implement precision antimicrobial therapy in the field are discussed in this article.

A mixed treatment comparison meta-analysis of metaphylaxis treatments for bovine respiratory disease in beef cattle

The objective of this project was to evaluate the effects of antimicrobials approved for parenteral metaphylactic use in feeder and stocker calves on morbidity and mortality for bovine respiratory disease with the use of a mixed treatment comparison meta-analysis. An initial literature review was conducted in April 2016 through Pubmed, Agricola, and CAB (Commonwealth Agricultural Bureau) for randomized controlled trials for metaphylaxis antimicrobial administered parentally to incoming feedlot or stocker calves within 48 h of arrival. The final list of publications included 29 studies, with a total of 37 trials. There were 8 different metaphylactic antimicrobials. Final event outcomes were categorized into bovine respiratory disease (BRD) morbidity cumulative incidence d 1 to ≤ 60 of the feeding period, BRD morbidity cumulative incidence d 1 to closeout of the feeding period, BRD mortality cumulative incidence d 1 to closeout of the feeding period, and BRD retreatment cumulative incidence morbidity d 1 to closeout of the feeding period. Network meta-analysis combined direct and indirect evidence for all the event outcomes to determine mean odds ratio (OR) with 95% credibility intervals (CrIs) for all metaphylactic antimicrobial comparisons. The "upper tier" treatment arms for morbidity d 1 to ≤ 60 included tulathromycin, gamithromycin, and tilmicosin. For BRD mortality cumulative incidence d 1 to closeout and BRD retreatment morbidity d 1 to closeout, classifying the treatment arms into tiers was not possible due to overlapping 95% CrIs. The results of this project accurately identified differences between metaphylactic antimicrobials, and metaphylactic antimicrobial options appear to offer different outcomes on BRD morbidity and mortality odds in feedlot cattle.

Pharmacokinetic-pharmacodynamic integration and modelling of oxytetracycline for the calf pathogens Mannheimia haemolytica and Pasteurella multocida

A calf tissue cage model was used to study the pharmacokinetics (PK) and pharmacodynamics (PD) of oxytetracycline in serum, inflamed (exudate) and noninflamed (transudate) tissue cage fluids. After intramuscular administration, the PK was characterized by a long mean residence time of 28.3 hr. Based on minimum inhibitory concentrations (MICs) for six isolates each of Mannheimia haemolytica and Pasteurella multocida, measured in serum, integration of in vivo PK and in vitro PD data established area under serum concentration-time curve (AUC_0-∞ )/MIC ratios of 30.0 and 24.3 hr for M. haemolytica and P. multocida, respectively. Corresponding AUC_0-∞ /MIC ratios based on MICs in broth were 656 and 745 hr, respectively. PK-PD modelling of in vitro bacterial time-kill curves for oxytetracycline in serum established mean AUC_0-24 hr /MIC ratios for 3log₁₀ decrease in bacterial count of 27.5 hr (M. haemolytica) and 60.9 hr (P. multocida). Monte Carlo simulations predicted target attainment rate (TAR) dosages. Based on the potency of oxytetracycline in serum, the predicted 50% TAR single doses required to achieve a bacteriostatic action covering 48-hr periods were 197 mg/kg (M. haemolytica) and 314 mg/kg (P. multocida), respectively, against susceptible populations. Dosages based on the potency of oxytetracycline in broth were 25- and 27-fold lower (7.8 and 11.5 mg/kg) for M. haemolytica and P. multocida, respectively.

Assessment of nebulisation of sodium ceftiofur in the treatment of calves naturally infected with bovine respiratory disease

Twelve screened cases of bovine respiratory disease (BRD) in calves were enrolled. Six of the calves were treated intramuscularly with sodium ceftiofur (1 mg/kg), and six were treated with nebulised sodium ceftiofur (1 mg/kg). Comparative evaluation of the two therapeutic modalities was based on repetitive analysis of hematological profile of calves on days 0, 5, and 10 post-therapy. The mortality rate in the group of calves treated with the nebulised sodium ceftiofur was significantly (p < 0.001) lower, and their clinical and hematological parameters returned to normal significantly (p < 0.001) faster than in calves treated intramuscularly. Nebulisation of sodium ceftiofur is the most effective treatment in calves with BRD under field conditions. Nasal lavage fluid analysis indicating a high rise of neutrophil count and macrophages may be used as an alternative method to detect pulmonary inflammation in BRD-affected calves.

A mixed treatment meta-analysis of antibiotic treatment options for bovine respiratory disease - An update

Bovine respiratory disease is the most economically important disease of feedlot cattle in North America. Choice of antibiotic is a critical factor for producers and veterinarians. We previously published a mixed-treatment comparison meta-analysis that combined evidence from published trials and published estimates of comparative efficacy for 12 antibiotics registered for use in the USA. Some of the comparative efficacy estimates were based only on indirect evidence. Since the original review was published, new studies that provide direct evidence of comparative efficacy have been published. We updated the original review to include the current evidence. We also compared the results from the indirect estimates from the prior model with the observed results from randomized control trials. We repeated the original search and found that five of the new studies met the criteria for inclusion in the updated review. Four of these studies provided new data on direct comparisons of active drugs. The results from one study (performed in 2002) that compared ceftiofur pinna and enrofloxacin were inconsistent with the network and were excluded from the analysis. Three new direct comparison studies examined gamithromycin compared with tulathromycin, florfenicol, and tilmicosin. The results of our analysis suggested that the indirect estimates from the prior model provided reasonable estimates of the risk ratios revealed by the primary studies. For example, for the comparison of gamithromycin (referent) with tulathromycin, the original model predicted a risk ratio of re-treatment of 0.54 (95% credible interval 0.27-0.87). The subsequent randomized controlled trial revealed that the observed risk ratio of re-treatment was 0.59 (95% confidence interval 0.45-0.78). The results of other comparisons were also similar. For the gamithromycin (referent) to florfenicol comparison, the observed randomized trial RR was 1.17 (95% confidence interval 0.83-1.64) and the indirect estimate of RR from the prior model was 0.84 (95% credibility interval 0.48-1.3). The gamithromycin to tilmicosin (referent) observed RR from the randomized trial was 0.99 (95% confidence interval 0.67-1.47) and the indirect estimate of RR from the prior model was 1.09 (95% credible interval 0.64-1.79). The results suggested that indirect estimates provided reasonable estimates of RR when direct data were not available.

Veterinary Medicine Needs New Green Antimicrobial Drugs

Given that: (1) the worldwide consumption of antimicrobial drugs (AMDs) used in food-producing animals will increase over the coming decades; (2) the prudent use of AMDs will not suffice to stem the rise in human antimicrobial resistance (AMR) of animal origin; (3) alternatives to AMD use are not available or not implementable, there is an urgent need to develop novel AMDs for food-producing animals. This is not for animal health reasons, but to break the link between human and animal resistomes. In this review we establish the feasibility of developing for veterinary medicine new AMDs, termed "green antibiotics," having minimal ecological impact on the animal commensal and environmental microbiomes. We first explain why animal and human commensal microbiota comprise a "turnstile" exchange, between the human and animal resistomes. We then outline the ideal physico-chemical, pharmacokinetic, and pharmacodynamic properties of a veterinary green antibiotic and conclude that they can be developed through a rational screening of currently used AMD classes. The ideal drug will be hydrophilic, of relatively low potency, slow clearance and small volume of distribution. It should be eliminated principally by the kidney as inactive metabolite(s). For oral administration, bioavailability can be enhanced by developing lipophilic pro-drugs. For parenteral administration, slow-release formulations of existing eco-friendly AMDs with a short elimination half-life can be developed. These new eco-friendly veterinary AMDs can be developed from currently used drug classes to provide alternative agents to those currently used in veterinary medicine and mitigate animal contributions to the human AMR problem.

Comparative efficacy of tulathromycin and tildipirosin for the treatment of experimental Mycoplasma bovis infection in calves

The objective of this negative controlled, blinded, randomised, parallel group study was to compare the efficacy of two injectable macrolide antimicrobials, tulathromycin and tildipirosin, administered by single subcutaneous injection at dose rates of 2.5 and 4.0 mg kg⁻¹ bodyweight, respectively, in the treatment of an experimentally induced Mycoplasma bovis infection in calves. A total of 238 M. bovis‐negative calves were challenged on three consecutive days with M. bovis by endobronchial deposition. Post‐challenge, a total of 126 animals fulfilled the inclusion criteria and were randomly allocated to three treatment groups: tulathromycin, tildipirosin and saline. Clinical observations for signs of respiratory disease and injection site assessments were conducted daily for 14 days post‐treatment. The animals were then killed, the lungs were examined for evidence of lesions, and samples collected for bacterial isolation. Calves treated with tulathromycin had a lower percentage of lung with lesions (P = 0.0079), lower mortality (P = 0.0477), fewer days with depressed demeanour (P = 0.0486) and higher body weight (P = 0.0112) than calves administered tildipirosin.

Impact of Timing and Dosage of a Fluoroquinolone Treatment on the Microbiological, Pathological, and Clinical Outcomes of Calves Challenged with Mannheimia haemolytica

The efficacy of an early and low inoculum-adjusted marbofloxacin treatment was evaluated on microbiological and clinical outcomes in calves infected with 4.10⁷ CFU of Mannheimia haemolytica A1. Twenty-two calves were included based on their rectal temperature rise in the 10 h after challenge and allocated in four groups, receiving a single intramuscular injection of saline (CON), 2 mg/kg marbofloxacin 2–4 h after inclusion (early treatment, E2), 2 or 10 mg/kg marbofloxacin 35–39 h after inclusion (late treatments, L2, L10). In CON calves, M. haemolytica DNA loads in bronchoalveolar lavages continuously increased from inclusion to day 4, and were associated with persistent respiratory clinical signs and lung lesions. At times of early and late treatments, M. haemolytica loads ranged within 3.5–4 and 5.5–6 log₁₀ DNA copies/mL, respectively. Early 2 mg/kg marbofloxacin treatment led to rapid and total elimination of bacteria in all calves. The late treatments induced a reduction of bacterial loads, but 3 of 6 L2 and 1 of 6 L10 calves were still positive for M. haemolytica at day 4. Except for CON calves, all animals exhibited clinical improvement within 24 h after treatment. However, early 2 mg/kg treatment was more efficacious to prevent pulmonary lesions, as indicated by the reduction of the extension and severity of gross lesions and by the histopathological scores. These results demonstrated for the first time that a reduced antibiotic regimen given at an early stage of the disease and targeting a low bacterial load could be efficacious in a natural bovine model of pneumonia.

Systematic review and meta-analysis of the effectiveness of commercially available vaccines against bovine herpesvirus, bovine viral diarrhea virus, bovine respiratory syncytial virus, and parainfluenza type 3 virus for mitigation of bovine respiratory disease complex in cattle

OBJECTIVE

To evaluate and analyze data from controlled studies on the effectiveness of vaccinating cattle with commercially available viral antigen vaccines for mitigation of the effects of bovine respiratory disease complex (BRDC).

DESIGN

Systematic review and meta-analysis.

SAMPLE

31 studies comprising 88 trials.

PROCEDURES

Studies that reported the effectiveness of commercially available bovine herpesvirus-1 (BHV-1), bovine viral diarrhea virus (BVDV), bovine respiratory syncytial virus (BRSV), and parainfluenza type 3 virus (PI3) vaccines for protection of cattle against BRDC or its components were included in the analysis. Studies or trials were categorized as natural exposure or experimental challenge and were further divided by the viral antigen evaluated and vaccine type (modified-live virus [MLV] or inactivated vaccine). Meta-analysis was performed; summary Mantel-Haenszel risk ratios were determined, and Forest plots were generated.

RESULTS

In natural exposure trials, beef calves vaccinated with various antigen combinations had a significantly lower BRDC morbidity risk than did nonvaccinated control calves. In trials evaluating BHV-1 and MLV BVDV vaccines in experimental challenge models, vaccinated calves had a lower BRDC morbidity risk than did control calves; however, in experimental challenge trials evaluating MLV BRSV and PI3 vaccines, no significant difference in morbidity or mortality risk was found between vaccinated and control calves.

CONCLUSIONS AND CLINICAL RELEVANCE

Estimating clinical efficacy from results of experimental challenge studies requires caution because these models differ substantially from those involving natural exposure. The literature provides data but does not provide sufficiently strong evidence to guide definitive recommendations for determining which virus components are necessary to include in a vaccination program for prevention or mitigation of BRDC in cattle.

Feeding behavior as an early predictor of bovine respiratory disease in North American feedlot systems

Bovine respiratory disease (BRD), which can cause substantial losses for feedlot operations, is often difficult to detect based solely on visual observations. The objectives of the current study were to determine a BRD case identification based on clinical and laboratory parameters and assess the value of feeding behavior for early detection of BRD. Auction-derived, mixed-breed beef steers (n = 213) with an average arrival weight of 294 kg were placed at a southern Alberta commercial feedlot equipped with an automated feed bunk monitoring system. Feeding behavior was recorded continuously (1-s intervals) for 5 wk after arrival and summarized into meals. Meals were defined as feeding events that were interrupted by less than 300 s nonfeeding. Meal intake (g) and meal time (min) were further summarized into daily mean, minimum, maximum, and sum and, together with frequency of meals per day, were fit into a discrete survival time analysis with a conditional log-log link. Feedlot staff visually evaluated (pen-checked) health status twice daily. Within 35 d after arrival, 76% (n = 165) of the steers had 1 or more clinical signs of BRD (reluctance to move, crusted nose, nasal or ocular discharge, drooped ears or head, and gaunt appearance). Whereas 41 blood samples could not be processed due to immediate freezing, for 124 of these steers, complete and differential blood cell count, total serum protein, plasma fibrinogen, serum concentration of haptoglobin (HP), and serum amyloid A (SAA) were determined. The disease definition for BRD was a rectal temperature ≥ 40.0°C, at least 2 clinical signs of BRD, and HP > 0.15 mg/mL. It was noteworthy that 94% of the 124 steers identified by the feedlot staff with clinical signs of BRD had HP > 0.15 mg/mL. An increase in mean meal intake, frequency, and mean inter-meal interval was associated with a decreased hazard for developing BRD 7 d before visual identification (P < 0.001). Furthermore, increased mean mealtime, frequency, and mean inter-meal interval were associated with a decreased BRD hazard up to 7 d before feedlot staff noticed clinical symptoms (P < 0.001). In conclusion, mean intake per meal as well as mean meal time and frequency of meals could be used to predict the hazard of BRD in feedlot cattle 7 d before visual detection and could be considered in commercial feedlot settings once a predictive algorithm has been developed.

Alterations in the Quinolone Resistance-Determining Regions and Fluoroquinolone Resistance in Clinical Isolates and Laboratory-Derived Mutants of Mycoplasma bovis: Not All Genotypes May Be Equal

Mycoplasma bovis is considered a major contributor to respiratory diseases in young cattle. Resistant M. bovis isolates have increasingly been reported worldwide due to extensive use of antimicrobials to treat bovine pneumonia. The frequency of isolates resistant to fluoroquinolones varies considerably from one country to another. The MICs of isolates collected in France have only increased from "very low" to "low." The present study was conducted to investigate whether alterations in the quinolone resistance-determining regions (QRDRs) could account for this slight modification in susceptibility. No correlation between QRDR alterations and increased MICs was evidenced in clinical isolates. In addition, all clinical isolates were subtyped, and the tendencies of the different sequence types to develop resistance through mutations in QRDRs under selective pressure in vitro were examined. In vitro, 3 hot spots for mutations in QRDRs (position 83 in GyrA and positions 80 and 84 in ParC) were associated with a high level of resistance when cumulated. We showed that the point mutations in the QRDRs observed in vitro were different (in location and selection rapidity) between the different subtypes. Our in vitro observations were corroborated by the recent detection of a clinical isolate highly resistant to fluoroquinolones (MIC ≥ 16 μg/ml) and belonging to the subtype which easily accumulates QRDR alterations in vitro. The current increased prevalence of this subtype in clinical isolates highlights the urgent need to control fluoroquinolone usage in veterinary medicine.

Feedlot Pharmaceutical Documentation: Protocols, Prescriptions, and Veterinary Feed Directives

The days of oral treatment instructions and loosely associated authorizations for the use of drugs in food animals are gone. Treatment protocols should include case definitions for treatment eligibility, detailed regimens, case definitions for treatment success and failure, directions for animal disposition, and mechanisms to prevent animals entering the food chain with violative residues. Prescriptions and veterinary feed directives (VFDs) will soon be necessary for almost all uses of antimicrobials in food animals. Although VFDs have a regulatory format, prescriptions may vary, but there are basic inclusions that should be present in any prescription.

A review of the expected effects of antimicrobials in bovine respiratory disease treatment and control using outcomes from published randomized clinical trials with negative controls

Bovine respiratory disease (BRD) remains a major disease from an economic and an animal welfare standpoint in beef production systems. Antimicrobial administration is a mainstay in the control of and therapeutic treatment of acute BRD. Judicious use of antimicrobials remains paramount to ensure efficacy of treatment remains acceptable. A systemic review was conducted in the scientific literature, the objective of which was to present a cumulative review of the data from published randomized clinical trials using a negative control in the treatment and control of BRD and using the number needed to treat as a means to effectively convey this information to bovine practitioners.

The clinical syndrome of BRD: what it is and what it is not

The clinical syndrome of bovine respiratory disease (BRD) continues to be a major challenge in bovine production systems. We are challenged by our ability to predict morbidity in groups of cattle, our ability to accurately diagnose and provide a prognosis for individual cases, and our ability to evaluate the results of preventive and therapeutic interventions in the field when production system data are the sole basis for analysis. However, we are fortunate to have perhaps the highest quantity and quality of negative-controlled, prospective, randomized, and masked clinical trial data for any disease in veterinary medicine. It is nevertheless important to recognize that case definitions in these studies may not be consistent or necessarily externally relevant, and that production data in these studies are often missing.

Antibiotic resistance--consequences for animal health, welfare, and food production

Most of the literature on the consequences of emergence and spread of bacteria resistant to antibiotics among animals relate to the potential impact on public health. But antibiotics are used to treat sick animals, and resistance in animal pathogens may lead to therapy failure. This has received little scientific attention, and therefore, in this article, we discuss examples that illustrate the possible impact of resistance on animal health and consequences thereof. For all animals, there may be a negative effect on health and welfare when diseases cannot be treated. Other consequences will vary depending on why and how different animal species are kept. Animals kept as companions or for sports often receive advanced care, and antibiotic resistance can lead to negative social and economic consequences for the owners. Further, spread of hospital-acquired infections can have an economic impact on the affected premises. As to animals kept for food production, antibiotics are not needed to promote growth, but, if infectious diseases cannot be treated when they occur, this can have a negative effect on the productivity and economy of affected businesses. Antibiotic resistance in animal bacteria can also have positive consequences by creating incentives for adoption of alternative regimes for treatment and prevention. It is probable that new antibiotic classes placed on the market in the future will not reach veterinary medicine, which further emphasizes the need to preserve the efficacy of currently available antibiotics through antibiotic stewardship. A cornerstone in this work is prevention, as healthy animals do not need antibiotics.

The application of knowledge synthesis methods in agri-food public health: recent advancements, challenges and opportunities

Knowledge synthesis refers to the integration of findings from individual research studies on a given topic or question into the global knowledge base. The application of knowledge synthesis methods, particularly systematic reviews and meta-analysis, has increased considerably in the agri-food public health sector over the past decade and this trend is expected to continue. The objectives of our review were: (1) to describe the most promising knowledge synthesis methods and their applicability in agri-food public health, and (2) to summarize the recent advancements, challenges, and opportunities in the use of systematic review and meta-analysis methods in this sector. We performed a structured review of knowledge synthesis literature from various disciplines to address the first objective, and used comprehensive insights and experiences in applying these methods in the agri-food public health sector to inform the second objective. We describe five knowledge synthesis methods that can be used to address various agri-food public health questions or topics under different conditions and contexts. Scoping reviews describe the main characteristics and knowledge gaps in a broad research field and can be used to evaluate opportunities for prioritizing focused questions for related systematic reviews. Structured rapid reviews are streamlined systematic reviews conducted within a short timeframe to inform urgent decision-making. Mixed-method and qualitative reviews synthesize diverse sources of contextual knowledge (e.g. socio-cognitive, economic, and feasibility considerations). Systematic reviews are a structured and transparent method used to summarize and synthesize literature on a clearly-defined question, and meta-analysis is the statistical combination of data from multiple individual studies. We briefly describe and discuss key advancements in the use of systematic reviews and meta-analysis, including: risk-of-bias assessments; an overall quality-of-evidence approach; engagement of stakeholders; Bayesian, multivariate, and network meta-analysis; and synthesis of diagnostic test accuracy studies. We also highlight several challenges and opportunities in the conduct of systematic reviews (e.g. inclusion of grey literature, minimizing language bias, and optimizing search strategies) and meta-analysis (e.g. inclusion of observational studies and approaches to address the insufficient reporting of data and significant heterogeneity). Many of these developments have yet to be comprehensively applied and evaluated in an agri-food public health context, and more research is needed in this area. There is a need to strengthen knowledge synthesis capacity and infrastructure at the regional, national, and international levels in this sector to ensure that the best available knowledge is used to inform future decision-making about agri-food public health issues.

Estimating the comparative clinical and economic consequences of tulathromycin for treatment of present or anticipated outbreaks of bovine respiratory disease in feedlot cattle in the United States

The goal of this study was to determine the clinical and economic impact of using tulathromycin as first line treatment for bovine respiratory disease (BRD) compared with other commonly used antimicrobials. Two decision trees were developed simulating the consequences of treating cattle at high risk of developing BRD [control model (CM)] or cattle with first clinical BRD episode [treatment model (TM)]. As comparators florfenicol and tilmicosin were considered in both models whereas enrofloxacin was included in the TM because it was only labeled for treatment of BRD at the time of development of the calculators. A total of 5 (CM) and 10 (TM) comparative clinical studies that reported efficacy data for the selected drugs and indications were identified as suitable for model population. The following outcomes were considered: first treatment success, number of subsequent BRD treatments, chronics, and mortalities. Cost parameters were considered from the perspective of the producer and included treatment costs (first treatment and retreatments) and costs of chronics and deaths derived from published sources for 2010 (default). The models allowed the estimation of clinical and economic consequences according to each individual trial outcomes. Treatment with tulathromycin resulted in more first treatment successes and fewer removals (chronics and deaths) in all comparisons. The average total number of antimicrobial treatments required for the management of BRD was also least with tulathromycin as first treatment option. Because of better efficacy, total costs over the entire study periods were always lowest with tulathromycin. Depending on the study selected as the basis for the efficacy evaluation, cost savings with tulathromycin were calculated in the CM between US$21.00 and $47.86 (vs. florfenicol) and $11.37 and $72.64 (vs. tilmicosin); cost savings in the TM ranged between $28.47 and $143.87 (vs. florfenicol) and $7.75 and $84.91 (vs. tilmicosin) as well as between $23.22 and $47.82 (vs. enrofloxacin), with the ranges reflecting a variety of settings in different trials. Thus, the higher drug costs of tulathromycin were more than offset by reduced BRD treatments, chronics, and mortalities in the herd. Fewer BRD episodes in cattle treated with tulathromycin not only contributes to overall savings in BRD management but also reduces the necessity of repeated antibiotic treatment, supporting prudent use of antimicrobials in livestock.