Alternative approaches to mitigate antimicrobial resistance in veterinary medicine through integrated One Health strategies

Antimicrobial resistance (AMR) in veterinary medicine is sustained by dependence on antibiotics for disease treatment, prophylaxis, and, in many production systems, growth promotion. Existing reviews of non-antibiotic alternatives typically treat each strategy, including probiotics, phage therapy, antimicrobial peptides, vaccination, biosecurity, and husbandry, as a self-contained topic, which leaves an important question unanswered: which of these strategies are mature enough for field deployment now, and which still depend on evidence too preliminary to support routine use? This review addresses that question directly. It synthesizes literature on eight intervention categories and introduces a comparative framework, developed by the authors and not derived from an external grading system, that classifies each strategy’s evidence base as strong, moderate, emerging, or mixed, and separately assesses field applicability, scalability, and regulatory maturity. The review distinguishes three outcomes that are frequently conflated in this literature: reduced pathogen burden, reduced antimicrobial use, and reduced antimicrobial resistance. An intervention that lowers antibiotic consumption does not automatically demonstrate an AMR-related benefit unless resistance itself, or a resistance-relevant proxy, was measured. Vaccination and biosecurity emerge as the most field-ready strategies, supported by national-scale intervention data. Bacteriophage therapy and antimicrobial peptides show a growing but still largely early-stage evidence base. Microbiome-based and breeding-based interventions remain the most heterogeneous in outcome and are the hardest to generalize across species and production systems. The review also traces an explicit One Health pathway from intervention to reduced antimicrobial exposure, altered selection pressure, and downstream implications for human and environmental health, while distinguishing demonstrated veterinary outcomes from plausible cross-sectoral effects that have not yet been measured directly. The principal implication for practice is that no single alternative is likely to substitute for antibiotics broadly. Layered combinations, matched to production system and disease ecology and paired with functioning surveillance, represent the more realistic path toward sustained antimicrobial reduction.