EVJ podcast puts equine antibiotic stewardship back in focus

Version 2 — Full analysis

Equine Veterinary Journal’s On the Hoof podcast episode 45, published May 14, 2025, puts antimicrobial stewardship squarely back on the agenda for equine practice. Hosted by James Bailey of the University of Nottingham, the episode revisits Bruce Bladon’s editorial, “Antibiotics: Our part in their downfall,” and connects it to research abstracts presented at BEVA Congress 2024, signaling that concern about antibiotic use in horses is moving from editorial debate toward practice measurement and accountability. (evj.podbean.com)

That context matters because equine medicine has often sat in a blind spot compared with other veterinary sectors. As trade coverage summarizing the BEVA journal collection noted, the UK has long monitored antibiotic usage in food animals through the Veterinary Antimicrobial Resistance and Sales Surveillance system, but there has been no equivalent national picture for equine practice. Bladon’s editorial project, and the surrounding virtual journal collection, were designed to pull together evidence on prescribing habits, resistance risk, and opportunities to change protocols before outside pressure forces the issue. (veterinary-practice.com)

The stewardship push also sits within a wider shift in equine primary care toward evidence-led, drug-sparing guidance. In EVJ’s May 2024 On the Hoof episode on BEVA primary care clinical guidelines for equine parasite control, Bailey described a similar problem: the profession has had to move on from older calendar-based worming schedules toward diagnosis-based treatment because resistance is increasing, new pharmaceuticals are scarce, and inconsistent opinion-led recommendations have undermined owner confidence and compliance. Those parasite-control guidelines were built around formal PICO questions and graded evidence using a GRADE-style framework, underscoring the same principle now being applied to antibiotics: routine use is harder to justify when resistance risk is rising and better-targeted approaches are available.

The research discussed around the editorial paints a mixed picture. On one hand, UK equine prescribing studies cited in the BEVA coverage suggest antibiotic use has fallen over time in some practice datasets, including a reported decline from 60 to 46 mg/kg across 14 equine practices between 2012 and 2021. On the other hand, those same summaries note continued use of highest-priority critically important antimicrobials, frequent reliance on potentiated sulphonamides, and prescribing rates that remain substantial in day-to-day care. One cited study reported systemic antimicrobial prescriptions in 19.5% of equids attended by UK practices in 2018, while active racehorses were more likely than non-racehorses to receive antibiotics. (veterinary-practice.com)

BEVA’s response has become more concrete in 2025. In February, the association urged practices to participate in MonitorME, a national campaign to collect antimicrobial use data directly from practice management systems. BEVA said the project is intended to create annual reports on equine antibiotic use and is being led by President Bruce Bladon as a central theme of his presidential year and of BEVA Congress 2025. In the association’s wording, the goal is to show that equine-sector antimicrobial use is “responsible and proportionate,” partly to protect continued access to these drugs if regulation tightens. (beva.org.uk)

Recent research outside the UK reinforces the same stewardship concerns. A 2025 JAVMA study from Cornell reviewing 1,622 equine visits in 2021 found systemic antimicrobials were prescribed in 33.5% of visits. Highest-priority critically important antimicrobials were used relatively infrequently, but the study still identified clear improvement areas: many clean surgical cases received antibiotics for more than 24 hours, about 24% of nonsurgical patients received antimicrobials without evidence of infection, and cultures were performed in only 15.7% of cases. The authors concluded that stewardship gains will depend on better justification, de-escalation decisions, and more routine diagnostic support. (pubmed.ncbi.nlm.nih.gov)

Professional guidance already points in that direction. The AAEP’s judicious use recommendations, as published by AVMA, advise clinicians to use culture and susceptibility testing when the organism or sensitivity pattern is unknown, avoid unnecessary combination therapy, and keep antimicrobial use aligned with evidence and regulatory requirements. That framework isn’t new, but the current conversation suggests equine practice is entering a phase where documenting adherence may matter almost as much as having the guidance in place. (avma.org)

The parallel with parasite control is useful because it shows how this kind of change tends to unfold in practice. In the 2024 EVJ podcast, Bailey noted that updated BEVA guidance was needed not just because of anthelmintic resistance, but also because of limited drug development and growing concern about ecological effects. The review process aimed to replace fragmented advice with consistent, evidence-synthesized recommendations and to identify research gaps. That is essentially the same territory antimicrobial stewardship is now entering in equine medicine: fewer assumptions, more diagnostics, clearer protocols, and more explicit justification for treatment choices.

Why it matters: For veterinary professionals, this story is really about infrastructure. Stewardship in equine practice can’t rely only on individual clinical judgment if the profession wants to defend access to important drugs and show regulators that prescribing is appropriate. The combination of editorial pressure, practice-level usage studies, and BEVA’s MonitorME initiative suggests the next standard of care may include more formal internal audits, cleaner antimicrobial records, sharper perioperative protocols, and stronger use of culture data to support treatment decisions. For ambulatory and mixed equine practices, that could mean closer scrutiny of prescribing patterns by indication, discipline, and case type, including whether racehorse medicine, foal care, dentistry, and respiratory disease management are driving disproportionate use. And, as with parasite control, the broader expectation is shifting from routine preventive drug use toward targeted treatment backed by evidence, diagnostics, and transparent reasoning. (veterinary-practice.com)

What to watch: The next signal will be whether MonitorME produces enough participation to establish meaningful national benchmarks, and whether BEVA Congress 2025 turns those data into practical targets for equine prescribing. If that happens, veterinary teams should expect more discussion around benchmarking, reduction goals, and when antibiotic access could become a policy issue rather than just a clinical one. It is also worth watching whether BEVA continues to develop primary-care guidance in the same evidence-graded style used for parasite control, because that would further normalize a targeted-use model across equine therapeutics rather than treating antimicrobial stewardship as a standalone issue. (beva.org.uk)