We are standing on the precipice of a return to a pre-antibiotic world where routine medical and veterinary procedures would become impossible.
This was the stark warning given at the 2026 National Equine Forum on 5 March, in a session titled “On the brink: equine health conditions we cannot ignore”. Philip Ivens, director of Buckingham Equine Vets, covered the growing threat of antibiotic resistance, and what the horse world can do about it.
“It’s hard to overstate what an age without antibiotics is, as patients and as healthcare professionals,” he said. “We have a duty of care, whether we work with horses, veterinary or human medicine, to try to protect antibiotics for the future.
“There will be parts of this talk that go to the depths of despair – but I hope it will end with positive sentiment for the future.”
Dr Ivens explained that there is an ongoing increase in populations of bacteria that are resistant to antibiotics, and that these resistant genes can move between bacteria species; people who work with horses, for example, can facilitate transfer of resistant populations.
“So it’s really important, this one health subject; whether we’re treating horses, companion animals, farm animals, humans, the effects of antibiotic resistance are the same,” he said.
“We take antibiotics for granted. For most of us, most of the time, we do not realise we’re standing on the precipice of returning to an era of medicine prior to the antibiotic age.”
Antibiotic resistance policies
Dr Ivens said all vets should have resistance policies at practice level, and that the British Equine Veterinary Association has a range of tools and policies aimed at responsible prescription of antibiotics. A new project involves collecting and assessing clinical data to help inform which antibiotic to give, and for how long. Collecting this may come at a higher cost but may also mean less antibiotic is needed.
“So what can we do as an equine community now?” he said. “We need to strengthen antimicrobial stewardship by yards and clinics. We need to prioritise culture and sensitivity testing where feasible, we need to improve infection prevention through wound care, biosecurity, and vaccination uptake, we need to reduce unnecessary antimicrobial use in bacterial conditions.
“Then we need to collaborate better across human health and environmental sectors in that one health initiative. So are we winning or losing? We are making progress in awareness, policy and surveillance, but biologically, resistance is still outpacing our interventions, and the equine sector has a critical role in stewardship, prevention and early adoption of new diagnostics.
“The next decade will determine whether resistance becomes manageable or catastrophic.”
Shift in approach
Jane Hodgkinson, professor of molecular veterinary parasitology at the University of Liverpool, covered another issue of growing resistance – to worming drugs.
H&H has reported extensively on this threat, as resistance has been recorded to all classes of equine wormers and no new ones are in the pipeline. Prof Hodgkinson said there has been a welcome shift towards appropriate, risk-based and targeted treatment rather than the blanket worming that can increase resistance.
“The most obvious thing people like me talk about is picking up poo from pasture, because you’re removing the source of infection, the essential development that needs to take place on pasture is not going to happen because you’re removing it,” she said. “Studies have shown that [poo-picking] twice a week will break that cycle of transmission.”
Owners should assess which horses are most at risk from parasites, such as young horses, and take measures such as not putting them on heavily grazed fields.
“A lot has happened while I’ve been working with the field, on really improving diagnostics and using them to guide treatment decisions,” she said.
Tools available
“The best example, I think most people do know, is using faecal egg counts, so you can direct your treatments to the horses that are going to either benefit the most. You’re using the tests to determine whether a drug should be used or not, and which drug, but increasingly people use egg counts to test that a drug has worked in the way they hope it has.”
Prof Hodgkinson encouraged use of available tools to assess whether horses are at risk of parasite infection.
“Moving forward, I think we have to do more work,” she said. “We have to work together – parasitologists like me, diagnosticians, prescribers, vets, other researchers – to try to establish what we’re going to do, faced with the reality of potential multi drug-resistant [parasites]. I don’t have solutions, but we do have challenges.”
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