Most veterinarians continue to recommend anthelmintic treatment programmes for horses that derive from knowledge and concepts more than 40 years old. However, much has changed since these recommendations were first introduced and current approaches routinely fail to provide optimal or even adequate levels of parasite control. There are many reasons for this. Recent studies demonstrate that anthelmintic resistance in equine parasites is highly prevalent and multiple-drug resistance is common in some countries, but few veterinarians take this into account when making treatment decisions or when recommending rotation of anthelmintics. Furthermore, the current approach of treating all horses at frequent intervals was designed specifically to control the highly pathogenic large strongyle, Strongylus vulgaris. But this parasite is now quite uncommon in managed horses in most of the world. Presently, the cyathostomins (small strongyles) are the principal parasitic pathogens of mature horses. The biology and pathogenesis of cyathostomins and S. vulgaris are very different and therefore require an entirely different approach. Furthermore, it is known that parasites are highly over-dispersed in hosts, such that a small percentage of hosts harbour most of the parasites. The common practices of recommending the same treatment programme for all horses despite great differences in parasite burdens, recommending prophylactic treatment of all horses without indication of parasitic disease or knowing what species of parasites are infecting the horses, recommending use of drugs without knowledge of their efficacy and failing to perform diagnostic (faecal egg count) surveillance for estimating parasite burdens and determining treatment efficacy, are all incompatible with current standards of veterinary practice. Consequently, it is necessary that attitudes and approaches to parasite control in horses undergo a complete overhaul. This is best achieved by following an evidence-based approach that takes into account all of these issues and is based on science, not tradition.