Abstract: This review summarizes the current research status and development trends of antibiotic alternatives in aquaculture, aiming to explore strategies for reducing antibiotic use and ensuring the safety of aquatic products. By analyzing the adverse impacts of antibiotic misuse in aquaculture, particularly the emergence and spread of drug-resistant pathogens, this study underscores the urgency of developing antibiotic alternatives. Based on a systematic review and comprehensive analysis of existing literature, it focuses on discussing the research status, mechanisms of action, as well as the advantages and disadvantages of various alternatives, including vaccines, probiotics, bacteriophages, egg yolk antibodies, phytobiotic components, antimicrobial peptides, quorum sensing inhibitors, and biosurfactants. Finally, the paper outlines future development trends, such as multi-target combination technologies, nanotechnology and intelligent drug delivery systems, and green synthetic biology. It proposes that research efforts should be intensified in elucidating mechanisms of action, enhancing bioavailability, and advancing large-scale application studies. This review aims to provide a forward-looking reference for the research and application of antibiotic alternatives in the aquaculture industry, thereby promoting its green transformation and sustainable development.