Aquaculture is a rapidly growing food industry that serves as an important source of protein worldwide. However, disease outbreaks continue to pose a major threat to production, often leading to economic losses and increased reliance on antibiotics for disease control. The excessive use of antibiotics in aquaculture has raised serious concerns due to its negative impacts on the environment, disruption of fish metabolism, and the emergence of antibiotic-resistant microorganisms that threaten public health. Various antibiotic alternatives, such as medical plants, Probiotics, Prebiotics, Aquatic organism products, organic acids, vaccines, bacteriophages, bacteriocins, quorum quenching, and chicken egg yolk immunoglobulin (IgY) have been explored as alternative strategies. These alternatives offer promising solutions to enhance disease resistance and maintain fish health while minimizing environmental impact. Hence, the adoption of such innovative and eco-friendly practices is essential for promoting sustainable aquaculture, ensuring animal welfare, and safeguarding human health.