Non-traditional treatments for endometritis in mares

Routine treatment for persistent mating-induced endometritis is directed at enhancing the clearance of accumulated fluid from the uterus and includes the use of ecbolic agents (oxytocin, prostaglandin F2a) which may be used alone or in combination with large-volume uterine lavage and administering antimicrobials if infection is diagnosed. However, traditional therapies are not always effective in resolving chronic uterine inflammation or infections. Treatment failure may be caused by uterine exudates, inspissated mucus or biofilm produced by some bacteria and yeast. Exudate can interfere with antibiotic penetration, whereas biofilm can confer antibiotic resistance. The endometrium of mares with delayed uterine clearance or chronic endometritis produces more mucus than reproductively healthy mares. Loss of cilia and abnormal mucus blanket provide areas for bacterial attachment. This review describes new strategies of endometritis treatment that may be added to typical therapy and includes intrauterine mucolytics, chelators, immunomodulators, corticosteroids, nonsteroidal antiinflammatory drugs and others.