Antibiotic resistance in equine dermatology: what should we do?

Antibiotic resistance is a growing concern worldwide and across species. This is especially important in horses with skin infections, as many of them are infected with Staphylococcus aureus, which can also colonize people. An increasing body of literature has documented colonization of horses with methicillin-resistant S aureus (MRSA) and transmission of MRSA between horses and veterinarians and vice versa. Colonization with MRSA does not always result in disease but has a potential impact on other horses, owners, handlers, and especially veterinarians. The WHO has published criteria to determine which antibiotics are critically important for people and ranked their level of priority. Increased pressure has been placed on the veterinary profession to limit antibiotic use to minimize selection for resistance, which can have an impact on human health. Horses have few approved antibiotics, and some of the injectables are third-generation cephalosporins, which belong to the critically important category. Due to the potential risk of transmission of resistant bacteria between horses and people, it is critical for veterinarians to change the approach toward antibiotics use and practice responsible antibiotic stewardship. To minimize antibiotic resistance, we should try to prevent infections in the first place by addressing the underlying disease. Once skin infections are present, it is important to use appropriate topical antimicrobial therapy, minimize the use of systemic antibiotics, practice proper hygiene, and educate owners about long-term management.