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Veterinary ophthalmology2026; 29(4); e70209; doi: 10.1111/vop.70209

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

Abstract: Antimicrobial resistance (AMR) is a growing challenge in veterinary ophthalmology, particularly in cases of bacterial keratitis, where progressive stromal infection can threaten vision and globe integrity within hours to days. This review synthesizes current evidence on pathogen distribution, antimicrobial susceptibility profiles, multidrug resistance (MDR) prevalence, and determinants of nonsusceptibility in veterinary patients, highlighting the emerging role of antibiotic-sparing alternatives. Across contemporary studies, Staphylococcus pseudintermedius, β-hemolytic streptococci, and Pseudomonas aeruginosa are consistently among the most frequently isolated pathogens. The highest MDR burdens are reported in referral populations and among methicillin-resistant staphylococci worldwide. Feline data remain comparatively limited but show regional variability in resistance patterns, while equine studies reveal temporal shifts in isolate distribution and a rising prevalence of methicillin-resistant organisms in tertiary settings. Recent topical antimicrobial exposure is the most consistently identified predictor of reduced culture positivity and elevated resistance rates in subsequent ocular isolates, highlighting the importance of early microbiologic sampling and judicious antibiotic use. Interpreting antimicrobial susceptibility testing (AST) in ophthalmology remains challenging because clinical breakpoints are generally derived from systemic dosing regimens, despite substantially higher, albeit transient, drug concentrations being achieved at the ocular surface following topical administration. Moreover, the ocular surface microenvironment, including tear proteins, inflammation, biofilm formation, and concurrent serum therapy, may substantially influence antimicrobial activity and therapeutic response. The review concludes with practical ophthalmology-specific stewardship recommendations, a One Health perspective on resistant ocular pathogens, and a forward-looking discussion of antibiotic-sparing adjuncts within a broader multimodal strategy to preserve antimicrobial effectiveness.
© 2026 The Author(s). Veterinary Ophthalmology published by Wiley Periodicals LLC on behalf of American College of Veterinary Ophthalmologists.
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Publication Date: 2026-06-23 PubMed ID: 42333014PubMed Central: PMC13287550DOI: 10.1111/vop.70209Google Scholar: Lookup
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  • Journal Article
  • Review

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This research article reviews the challenge of antimicrobial resistance (AMR) in veterinary ophthalmology, focusing on bacterial infections of the eye, especially bacterial keratitis.
  • It evaluates the distribution of pathogens, resistance patterns, and alternatives to antibiotics, emphasizing stewardship strategies to preserve antibiotic efficacy.

Pathogen Distribution in Veterinary Ophthalmology

  • The most common bacterial pathogens isolated from veterinary ocular infections include:
    • Staphylococcus pseudintermedius
    • β-hemolytic streptococci
    • Pseudomonas aeruginosa
  • These pathogens are consistently reported across contemporary studies involving various animal species.
  • In equine populations, there have been temporal changes in predominant isolates and an increase in methicillin-resistant organisms in referral or tertiary care settings.
  • Data involving cats are more limited but demonstrate regional differences in resistance patterns.

Antimicrobial Resistance and Multidrug Resistance (MDR)

  • MDR is particularly common among:
    • Referral populations where animals are typically more clinically complex.
    • Methicillin-resistant staphylococci, which pose a global concern.
  • Recent topical antibiotic use consistently correlates with:
    • Reduced likelihood of positive bacterial culture, partly due to suppression of susceptible bacteria.
    • Increased rates of resistance among subsequent ocular isolates, indicating selective pressure for resistant strains.
  • This highlights the critical importance of early microbiologic sampling before initiating antibiotics to guide targeted therapy.

Challenges in Antimicrobial Susceptibility Testing (AST) for Ophthalmology

  • Clinical breakpoints used in susceptibility testing are typically established based on systemic antibiotic dosing, not topical administration.
  • Topical eye treatments achieve much higher but short-lived drug concentrations at the ocular surface compared to systemic doses.
  • This discrepancy complicates the interpretation of laboratory AST results in the context of ocular infections.
  • Additionally, complex factors affecting the eye’s microenvironment influence treatment outcomes:
    • Tear proteins can bind drugs, reducing activity.
    • Inflammation may alter drug penetration and bacterial susceptibility.
    • Biofilm formation by bacteria can protect organisms from antibiotics.
    • Concurrent systemic therapies may interact with topical treatments.

Stewardship and Antibiotic-Sparing Strategies

  • The article emphasizes ophthalmology-specific antibiotic stewardship practices, including:
    • Judicious and appropriate use of antibiotics based on culture and sensitivity.
    • Minimizing unnecessary topical antimicrobial exposure to reduce resistance development.
    • Implementing early diagnostic sampling before treatment.
  • A One Health perspective is advocated, recognizing that resistant ocular pathogens have implications beyond individual animal health, affecting human and environmental health.
  • Antibiotic-sparing adjunctive treatments are emerging as promising strategies, such as:
    • Use of non-antibiotic antimicrobials or anti-inflammatory agents that reduce bacterial burden without promoting resistance.
    • Application of multimodal treatments that combine various therapies to improve outcomes while lowering reliance on antibiotics.
  • The review looks ahead to integrating these strategies into clinical practice to maintain antimicrobial effectiveness over time.

Cite This Article

APA
Sebbag L, Pe'er O. (2026). Antibiotics in Veterinary Ophthalmology: Resistance, Stewardship, and Emerging Antibiotic-Sparing Strategies. Vet Ophthalmol, 29(4), e70209. https://doi.org/10.1111/vop.70209

Publication

Veterinary ophthalmology
ISSN: 1463-5224
NlmUniqueID: 100887377
Country: England
Language: English
Volume: 29
Issue: 4
Pages: e70209
PII: e70209

Researcher Affiliations

Sebbag, Lionel
  • Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel.
Pe'er, Oren
  • Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Rehovot, Israel.

MeSH Terms

  • Animals
  • Anti-Bacterial Agents / therapeutic use
  • Eye Infections, Bacterial / veterinary
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / microbiology
  • Antimicrobial Stewardship
  • Drug Resistance, Bacterial
  • Ophthalmology
  • Drug Resistance, Multiple, Bacterial
  • Horses

Conflict of Interest Statement

The authors declare no conflicts of interest.

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