Background/Objectives: A mandatory monitoring of the use of antibiotics in horses in the European Union will come into force from 2027 on. The aim of the study was to explore the potential implementation of a monitoring system and to provide an overview of antibiotic use in horses in Germany. Methods: Data on all consultations from 57 German practices between 2018 and 2023 were obtained. The dataset included basic data about the horse, free-text diagnoses (allocated to one of 20 categories), and treatments. Information on the administered or dispensed pharmaceutical product was recorded for antibiotic treatment consultations. Results: This study analyzed 225,622 consultations with more than 50,000 horses. Antibiotics were administered in around 7% of consultations, but practice-specific rates varied considerably. Treatment was most frequent in ophthalmology cases. The most commonly used drug classes were sulfonamides combined with trimethoprim and aminopenicillins. Horses receiving antibiotics required follow-up visits more often than untreated animals, and changes in antibiotic substance occurred occasionally. Conclusions: Routine practice data provide valuable insights into antibiotic use in equine medicine. While incomplete entries and imprecise details (e.g., missing concentrations or diagnoses) remain a limitation, the approach offers clear advantages: it is cost-effective, allows large-scale data collection, and supports continuous monitoring over time. Such systems can be used to evaluate the effects of upcoming EU regulations and to identify priorities for antibiotic stewardship in equine practice.
