The effect of various therapeutics on reproductive performance in bovine clinical endometritis: A meta and network meta-analysis.

Clinical endometritis (CE) is one of the most prevalent postpartum condition and is significantly linked to poor reproductive performance in dairy cows. The objective of the present study was to conduct the meta-analysis (MA) and network meta-analysis (NMA) to assess the effect of various therapeutic agents on reproductive performance in bovine CE. The literature was searched using the keywords, 'Endometritis' and "Cows OR Cow OR Cattle OR Bovine" on PubMed, Google Scholar, and Science Direct database and retrieved 1386 records. After screening and eligibility assessment, 33 randomized control trials (RCT) were included in the analysis. Owing to lesser number of available studies on each therapeutic agents, it was classified into antibiotic, prostaglandin (PG), antiseptic, alternate therapy and no treatment or placebo (control group) to conduct the MA and NMA. The MA was done using Cochrane guidelines and statistical analysis was performed using RevMan 5.4 software. Further, risk of biasness assessed using RoB2 tool. The NMA was conducted using the MetaInsight. The MA revealed that the antibiotic had better recovery rate (RR) than antiseptic and the control group with moderate to high heterogeneity with wide CI and asymmetry of funnel plot. While PG improved the first service conception rate (FSCR) compared to antibiotic (I2 = 0% and fairly symmetrical funnel plot). However, NMA revealed that control group had the highest SUCRA score for RR, FSCR and CR. The analysis suggests a need to critically reconsider the reliance on antibiotics and PG for CE treatment and emphasizes the necessity for more RCT.