<p>Bovine mastitis remains one of the most widespread and economically significant diseases affecting the dairy sector in Pakistan. Despite being a leading global milk producer, Pakistan’s dairy industry faces persistent challenges in controlling mastitis, particularly among smallholder farmers with limited access to veterinary care and diagnostic tools. Antibiotics are frequently used to manage mastitis, often without veterinary oversight, contributing to the growing concern of antimicrobial resistance (AMR). The widespread presence of <i>Staphylococcus aureus</i>, a biofilm-forming pathogen, further complicates treatment and accelerates resistance development. Pakistan has initiated efforts to address AMR through national action plans. However, gaps remain in surveillance, responsible antibiotic use, and access to affordable alternatives. This review examines the current landscape of bovine mastitis in Pakistan, including its epidemiology, economic impact, therapeutic practices, and AMR trends. It also outlines practical, low-cost recommendations for improving mastitis management and reducing inappropriate use of antibiotics, particularly in rural settings. Addressing these interconnected challenges through locally adapted, sustainable approaches is essential for improving animal health, milk safety, and long-term productivity in Pakistan’s dairy sector, whilst addressing the global challenge of AMR.</p>