Mastitis treatment decisions have major implications for dairy cow welfare, antibiotic stewardship, and milk safety. Clinical mastitis causes acute pain; welfare-positive treatment requires rapid intervention with appropriate analgesics alongside antimicrobial therapy where indicated. NSAIDs (meloxicam, ketoprofen) administered at diagnosis reduce inflammatory pain, restore milk production faster, and improve welfare outcomes. Not all clinical mastitis requires antibiotics: mild cases caused by environmental pathogens frequently resolve with supportive care alone. Selective treatment protocols based on milk culture results reduce antibiotic use by 30-50% while maintaining cure rates. Extended antibiotic therapy improves cure rates for contagious pathogens (Staph aureus) but risks antibiotic residues and resistance. Welfare monitoring of treated cows using activity sensors and milk yield data detects treatment failure early. Research demonstrates that cow-side culture tools enabling same-day treatment decisions improve both welfare outcomes and antibiotic stewardship.