Antibiotics in Veterinary Ophthalmology: Resistance, Stewardship, and Emerging Antibiotic-Sparing Strategies.

Early microbiologic sampling and judicious antibiotic stewardship preserve efficacy against ocular pathogens.

This comprehensive review addresses the critical challenge of antimicrobial resistance (AMR) in veterinary ophthalmology, particularly concerning bacterial keratitis where rapid progression threatens vision and globe integrity. The authors synthesize evidence on pathogen epidemiology, resistance patterns, and emerging strategies. Key findings reveal Staphylococcus pseudintermedius, β-hemolytic streptococci, and Pseudomonas aeruginosa as most frequently isolated pathogens, with highest multidrug resistance (MDR) burdens in referral settings and methicillin-resistant organisms rising globally. Prior topical antibiotic exposure emerges as the strongest predictor of reduced culture positivity and elevated resistance. A significant challenge highlighted is the misalignment between clinical breakpoints—derived from systemic dosing—and actual topical ocular drug concentrations, which are substantially higher but transient. The ocular surface microenvironment, including tear proteins, inflammation, and biofilm formation, substantially influences antimicrobial efficacy. The review concludes with practical stewardship recommendations, One Health perspectives on resistant pathogens, and discussion of antibiotic-sparing adjuncts to preserve antimicrobial effectiveness through multimodal therapeutic strategies.

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