Effect of footbath protocols for prevention and treatment of digital dermatitis in dairy cattle: A systematic review and network meta-analysis.

Digital dermatitis (DD) is an infectious bacterial disease affecting cattle feet. Footbaths are a common herd-level control method for DD; however, variations in product, concentration, and frequency of use complicate comparisons between protocols. The objective of this systematic review was to evaluate all walk-through footbath protocols reported that determined efficacy for prevention and treatment of DD lesions in dairy cattle. An extensive literature search was conducted, including electronic databases and gray literature updated until March 2018. Studies identified included all liquid walk-through footbath protocols that were compared to other footbath protocols or no footbath. Only studies with treatment or prevention of DD lesions as an outcome were included. Literature search and subsequent screening identified 14 publications with 24 treatment comparisons and 24 prevention comparisons. Studies included mostly had low and/or unclear risks of bias. Descriptive analyses were performed according to prevention and treatment outcomes, with case and success definitions summarized as odds ratios (OR). A subsequent network meta-analysis was conducted of 11 studies, comparing 17 protocol comparisons for the prevention outcome and 10 studies comparing 19 protocol comparisons for the treatment outcome, using semi-informative priors in a Bayesian statistical framework. Results of a random effects Bayesian network meta-analysis indicated only 5% copper sulfate used at least 4 times/wk was superior to both no footbath (OR: 5.26; 95% CrI: 1.27-28.8) and a water placebo (OR: 9.47; 95% CrI: 1.03-85.8) in treatment of DD. No other protocol was associated with a reduction in DD, and there were no differences in pair-wise comparisons between any active treatments. Unfortunately, for both outcomes (treatment and prevention), small sample sizes (adjusted for clustering) limited the power to detect substantial differences between protocol effects. Thus, despite widespread use of footbaths, limited strength of evidence for use remains and standardized protocols with large sample sizes are needed to further investigate effectiveness of footbath protocols for control of DD. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.