Antibiotic use in equine dentistry: What is the evidence?

Summary Antimicrobial resistance (AMR) poses a major threat to human and veterinary health. In equine dentistry, antibiotics are commonly used despite limited evidence supporting their efficacy. While antimicrobials include antifungals, antivirals, parasiticides and antiseptics, this review focuses specifically on antibiotics, aiming to inform responsible prescribing practices. Prophylactic antibiotic use around dental procedures remains widespread, yet evidence suggests it is often unnecessary. Horses appear less susceptible than other species to complications such as bacteraemia‐induced endocarditis, and post‐operative infection rates following dental extractions are low. Routine perioperative antibiotics have not been shown to significantly reduce complications. Targeted antibiotic therapy may be justified in high‐risk cases, including systemic illness, extensive oral trauma, osteomyelitis or severe apical infection. Even in these scenarios, surgical intervention remains primary and antibiotics should not replace procedures such as exodontia. Antibiotic use carries risks, including disruption of the oral and gastrointestinal microbiomes and promotion of resistance. These risks highlight the need for evidence‐based prescribing that balances potential benefits against adverse effects. Despite their widespread use, data on equine dental antibiotic prescribing, pathogen susceptibility, and resistance trends remain limited. Improved surveillance and research are needed to support rational use. This review advocates for judicious, evidence‐based antibiotic use, guided by clinical indications, pharmacokinetics and microbiology, aligning equine practice with One Health objectives and preserving antibiotic efficacy.