<p>The escalating issue of antimicrobial resistance (AMR) in <i>Pseudomonas aeruginosa</i> (<i>P. aeruginosa</i>), particularly in the equine context, poses a significant threat to veterinary and public health. This systematic review and meta-analysis aimed to assess the current landscape of AMR in <i>P. aeruginosa</i> strains isolated from equine sources. Adhering to the PRISMA guidelines, a comprehensive literature search was conducted, and data from eligible studies were extracted and synthesized. The review included 10 articles reporting on 1624 <i>P. aeruginosa</i> isolates. High resistance rates were found for several antimicrobial classes, with particular concern for increasing resistance to imipenem, amikacin, and ceftiofur. The study also identifies significant temporal trends and regional variations in resistance patterns. Asia reported the highest average resistance rates, suggesting potential misuse of antimicrobials in the region. The most effective antimicrobials were found to be aztreonam, fosfomycin, ciprofloxacin, and ceftazidime. However, the generalizability of these findings is limited by the small number of eligible studies (<i>n</i> = 10) and the scarcity of isolates for certain antimicrobial classes. The findings of this review highlight the critical need for innovative strategies, stringent antimicrobial stewardship, and comprehensive risk assessment to combat the escalating threat of AMR in equine-associated <i>P. aeruginosa</i> and preserve the efficacy of our existing antimicrobial agents.</p>