Antibiotic use in equine dentistry: What is the evidence?
Authors: A. Sidwell, S. L. Hole, R. Pereira
Journal: Equine Veterinary Education
Summary
# Editorial Summary: Antibiotic Use in Equine Dentistry Antimicrobial resistance represents a critical threat to both human and veterinary medicine, yet prophylactic antibiotics remain routinely prescribed in equine dental practice despite scant evidence of benefit. Sidwell, Hole and Pereira conducted a comprehensive evidence review to examine whether this widespread practice is justified, considering that horses appear inherently resistant to serious complications such as bacteraemia-induced endocarditis and typically experience low post-operative infection rates following extractions. Their findings suggest that routine perioperative antibiotics do not significantly reduce complications in straightforward dental cases, though targeted therapy may be warranted in high-risk scenarios including systemic illness, extensive oral trauma, osteomyelitis or severe apical infection—where surgical intervention remains the primary treatment. The authors emphasise that antibiotic use carries genuine costs: disruption of both oral and gastrointestinal microbiomes and selection pressure for resistance, risks that outweigh benefits in many routine situations. For equine practitioners, this review signals a shift towards evidence-based prescribing protocols that reserve antibiotics for clinically indicated cases rather than routine prophylaxis, whilst acknowledging that improved surveillance data on equine dental pathogens and resistance patterns would better inform future guidance.
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Practical Takeaways
- •Stop routinely prescribing prophylactic antibiotics for routine dental work in healthy horses—the evidence does not support this practice and it contributes to resistance
- •Reserve antibiotics for high-risk cases only: systemic illness, extensive trauma, osteomyelitis, or severe apical infection, but remember antibiotics should complement (not replace) surgical intervention like extraction
- •When antibiotics are indicated, base decisions on clinical findings, pharmacokinetics, and microbiology rather than habit; improved surveillance data on equine dental pathogens and resistance patterns is still needed
Key Findings
- •Prophylactic antibiotics around equine dental procedures lack supporting evidence and are often unnecessary
- •Post-operative infection rates following equine dental extractions are low and routine perioperative antibiotics do not significantly reduce complications
- •Horses are less susceptible than other species to bacteraemia-induced endocarditis following dental procedures
- •Antibiotic use disrupts oral and gastrointestinal microbiomes and promotes antimicrobial resistance, necessitating evidence-based prescribing approaches