Randomized clinical trial to assess the effect of antibiotic therapy on health and growth of preweaned dairy calves diagnosed with respiratory disease using respiratory scoring and lung ultrasound

The primary objective of this randomized field study was to assess the effect of antibiotic therapy on health and growth of preweaned dairy calves diagnosed with naturally occurring respiratory disease, using respiratory scoring and portable lung ultrasound. A secondary objective was to determine whether treatment response depended on clinical presentation at the time of diagnosis. Holstein calves (n = 357) were enrolled at 3 to 6 d of age and followed until 52 d on 2 commercial dairies. Calves were examined twice weekly by blinded members of the research team. Clinical respiratory and ultrasonographic lung scores were assigned at each exam and used to classify the first detected respiratory disease event (BRD1) into upper respiratory tract disease (clinical, no significant consolidation); subclinical lobular pneumonia (not clinical, patchy consolidation ≥1 cm2); clinical lobular pneumonia (clinical, patchy consolidation ≥1 cm2); subclinical lobar pneumonia (not clinical, ≥1 lobe consolidated); and clinical lobar pneumonia (clinical, ≥1 lobe consolidated). At BRD1, calves were blocked by their respiratory disease status and randomized to receive an antibiotic (tulathromycin, 2.5 mg/kg subcutaneous) or placebo (sterile saline, equal volume subcutaneous). Multivariable linear and logistic regression analyses were used to model response to therapy. At BRD1 (n = 289), the distribution of diagnoses was 29% (upper respiratory tract disease), 43% (subclinical lobular pneumonia), 13% (clinical lobular pneumonia), 8% (subclinical lobar pneumonia), and 7% (clinical lobar pneumonia). Early antibiotic therapy limited progression of lung consolidation immediately following treatment, reduced the likelihood of requiring treatment within 7 d of BRD1, and improved growth and mortality before weaning. Despite receiving multiple doses of antibiotics after BRD1, calves treated with either antibiotic or placebo were equally likely to enter the weaning phase with pneumonia. Clinical presentation was associated with response to treatment for worsening of consolidation, early treatment failure, days to retreatment, and average daily gain. Overall, treatment was associated with short-term benefits, but more research is needed to develop treatment protocols that more effectively treat pneumonia and ensure that calves enter the weaning period with ultrasonographically clean lungs.