Aquaculture has emerged as one of the fastest-growing food production sectors and is essential for global food and nutritional security. However, the increasing use of antibiotics to control bacterial diseases has contributed to the emergence and spread of antimicrobial resistance (AMR), a major threat to aquatic animal health, environmental sustainability, and public health. Aquatic environments serve as important reservoirs of antibiotic residues, resistant bacteria, and resistance genes, facilitating their dissemination through water systems, seafood, and interactions between farmed and wild organisms. The rise of AMR compromises disease management, reduces treatment efficacy, and leads to significant economic losses in aquaculture. Moreover, the interconnected nature of humans, animals, and the environment highlights the need for a One Health approach to address this growing challenge. Sustainable alternatives, including vaccination, probiotics, improved biosecurity, and precision technologies, offer promising solutions to reduce antibiotic dependence. Combating AMR requires coordinated global efforts to ensure the long-term sustainability and resilience of aquaculture systems.