From Detection to Decision in Bovine Mastitis: An Actionability-Centred Framework for Precision Management and Antimicrobial Stewardship

Bovine mastitis management requires decisions that reflect clinical severity, pathogen biology, and diagnostic timing. This critical narrative review links evidence on diagnostics, antimicrobial stewardship, and emerging therapies to the decisions that can support them. Randomized field studies support culture-guided selective treatment in eligible non-severe cases; however, these findings do not justify delaying care in systemically ill cows. We propose three unvalidated organizing concepts: a three-clock model of concurrent pathogen dynamics, inflammatory injury, and decision latency; ACT-MAST (Assess, Characterize, Tailor, Monitor, Audit, Scale, and Translate); and a six-stage translational evidence staircase primarily for therapeutic development, with a separate diagnostic adaptation. Their proposed contribution is to make timing, uncertainty, reassessment, and evidence maturity explicit within existing severity-based and culture-guided approaches. We provide illustrative case pathways, proposed candidate outcomes, and testable prospective endpoints; these are author proposals, not treatment guidelines or a consensus core outcome set. Laboratory activity, experimental challenge efficacy, and effectiveness in naturally infected cows are distinguished. The narrative selection process, incomplete search provenance, heterogeneous outcome definitions, and limited field evidence constrain inference. Prospective comparative studies are required to determine whether the proposed frameworks improve welfare, antimicrobial exposure, recurrence, or protocol-level costs beyond established care.