Regular anthelmintic treatment has contributed to anthelmintic resistance in horse helminths. This mass anthelmintic treatment was originally developed owing to a lack of larvicidal drugs against Strongylus vulgaris. The high prevalence of anthelmintic resistance and shortening of strongyle egg reappearance period after avermectins/moxidectins requires epidemiologically appropriate and sustainable measures. Selective anthelmintic treatment is a much-needed deworming approach: More than 50% of adult horses manifest no strongyle egg excretion. In this article, selective anthelmintic treatment procedure is described, with the specific focus on the advantages of an evidence-based, medically appropriate, and sustainable treatment system that slows the development of anthelmintic resistance.