Possible association of short-term complications and antimicrobial use in standing equine cheek tooth extractions 2018-2022.
Authors: Schnierer Marlies, Nekouei Omid, Huber Lisa Christina, Jehle Matthias, Biermann Nora
Journal: Equine veterinary journal
Summary
# Editorial Summary: Antimicrobial Use in Standing Cheek Tooth Extractions—Evidence for Selective Rather Than Routine Administration Prophylactic antimicrobials are commonly given during equine dental extractions despite growing antimicrobial resistance concerns, yet limited evidence supports this practice. A retrospective analysis of 305 horses undergoing 447 standing cheek tooth extractions between 2018–2022 examined whether antimicrobial administration reduced post-operative complications and identified risk factors for adverse outcomes. Remarkably, 35.4% of cases received no antimicrobials, and this group experienced comparable complication rates (18.4% overall; 5.6% requiring veterinary intervention) to those receiving prophylaxis—suggesting routine administration may be unnecessary for many horses. Complications were significantly more likely with concurrent systemic disease (OR 4.32), mandibular extractions (OR 2.20), dental infections (OR 6.37) or fractures (OR 3.90), and warmer seasons (OR 1.97), whilst antimicrobial use itself was paradoxically associated with higher complication rates (OR 2.69), likely reflecting clinician selection of riskier cases for treatment. For equine practitioners, this evidence supports a risk-stratified approach: withholding routine prophylaxis in uncomplicated cases whilst reserving antimicrobials for horses with concurrent disease, infected teeth, or multiple extractions—an approach that would reduce unnecessary antimicrobial exposure without compromising patient outcomes.
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Practical Takeaways
- •Routine prophylactic antimicrobials may not be necessary for all standing cheek tooth extractions; reserve them for horses with concurrent diseases or high-risk cases
- •Mandibular extractions, dental infections, and extractions of multiple teeth carry higher complication risk and warrant closer monitoring
- •Document cases without antimicrobials to build evidence-based protocols that reduce unnecessary antimicrobial use while maintaining safety
Key Findings
- •Complications occurred in 56 cases (18.4%), with 12.7% mild/transient and 5.6% severe requiring veterinary treatment
- •Antimicrobial use was associated with increased complication rates (OR 2.69; p=0.02), suggesting complications may prompt antimicrobial use rather than antimicrobials preventing complications
- •Concurrent diseases (OR 4.32; p=0.001), mandibular extractions (OR 2.20; p=0.018), warmer seasons (OR 1.97; p=0.04), and extraction reason (dental infection OR 6.37, fracture OR 3.90) were significant risk factors
- •Many horses (35.4%) did not receive antimicrobials without resulting in higher complication rates, challenging routine prophylactic use