Antibiotic use in first opinion equine practice in the United Kingdom: Serial point prevalence surveys in 17 practices

Background: Monitoring antibiotic use (AMU) is a key component of antimicrobial stewardship. Published data on AMU in first opinion equine practice are limited.Objectives: To document AMU in first opinion equine practices.Study design: Repeated point prevalence surveys.Methods: AMU was recorded one day every month for 12 consecutive months in 17 equine practices.Results: Two hundred and fifty-two horses were prescribed antibiotics across 2273 consultations (excluding routine appointments) (11.1%; 95% CI 9.8%-12.4%). Median number of consultations per practice was 121 (IQR 112-159; range 27-303). Across 17 practices, the proportion of horses receiving antibiotics varied by practice from 0% to 26.4%. Commonest indications for AMU included cellulitis (66; 26.8%), wounds (46; 18.7%), surgical prophylaxis (36; 14.6%), respiratory infection (27; 11.0%) and skin infection (20; 8.1%). Commonest antibiotics prescribed were potentiated sulphonamides (109; 43.6%), oxytetracycline (58; 23.2%), procaine penicillin (40; 16.0%) and doxycycline (36; 14.4%). 45.0% of oxytetracycline use was for surgical prophylaxis. 44.8% of procaine penicillin use was for cellulitis. 28.6% of 'other antimicrobial' use was for pyrexia of unknown origin. Use of antibiotics differed significantly depending on the underlying diagnosis (p < 0.001). Median antibiotic dose rates were: potentiated sulphonamides 30 mg/kg (IQR 27-75; range 10-75; n = 96); procaine penicillin 19 mg/kg (IQR 15-23; range 7-30; n = 35); oxytetracycline 6 mg/kg (IQR 5-6; range 4-30; n = 55); doxycycline 10 mg/kg (IQR 10-20; range 7-30; n = 34).Main limitations: Weight of horses were often estimated. Duration of antibiotic courses was not recorded.Conclusions: Antibiotics were prescribed in 11% of nonroutine consultations. Commonest indication for AMU was cellulitis. Potentiated sulphonamides, oxytetracycline and procaine penicillin were the commonest prescribed drugs. Critically important antibiotic use was infrequent. Dose rates varied, but median values were generally appropriate.