Abstract With the rapid growth of the aquaculture production since the 1980s, there has been a concomitant increase in disease outbreaks. The injudicious and/or incorrect use of antimicrobial agents against diseases of farmed aquatic species poses a considerable threat to the development and growth of a successful and sustainable aquaculture industry. An increase in antimicrobial resistance (AMR) is an important consequence, resulting to the difficulty in treating common bacterial diseases in populations of aquatic organisms, combined with the presence of antibiotic residues in food fish and their products, leading to import refusals and negative impacts on international trade. To reduce the frequency of AMR, good aquaculture and effective biosecurity practices should include the prudent and responsible use of antibiotics and also consider the use of alternatives to antibiotics, in addition to disease prevention management. This article reviews the literature discussing the scope of the problem pertaining to antibiotic use, the emergence of AMR in aquaculture and to consider and discuss viable alternatives (e.g., vaccination, bacteriophages, quorum quenching, probiotics and prebiotics, chicken egg yolk antibody and medicinal plant derivative). We also discuss lessons learnt, from specific case studies such as the vaccination of farmed salmon in Norway and the use of ‘specific pathogen‐free’ seed—as primary and essential part of a biosecurity strategy.