Aquaculture is a key to global food and nutrition security, but intensification has increased disease pressure, antibiotic use, antimicrobial resistance (AMR), and wider One Health concerns. Functional microbial products (FMPs), including probiotics, prebiotics, synbiotics, postbiotics, and paraprobiotics, are widely promoted as sustainable alternatives to antibiotics. However, their growing use has not resulted in sustained replacement of antibiotics in commercial aquaculture practice. This review examined why this gap persists and what conditions are required for these products to contribute credibly to antibiotic reduction. A PRISMA‐guided systematic review was conducted across major scientific databases, yielding 654 records, of which 97 studies were retained for qualitative synthesis. The evidence shows that FMPs can improve growth, feed efficiency, immune response, disease resistance, survival, and, in some systems, water quality. Beyond these performance outcomes, the review identifies host immune modulation as a central biological pathway linking FMPs to disease resilience, particularly through mucosal barrier reinforcement, innate immune priming, activation of humoral and cellular defenses, cytokine and inflammatory regulation, antioxidant protection, and stabilization of the host–microbiome axis. Probiotics had the strongest overall evidence base, synbiotics showed the most consistent combined gains across growth, immunity, and survival, while postbiotics emerged as promising options because of their stability and biosafety advantages. However, direct evidence of sustained farm‐level reductions in antibiotic use remains limited. Multiple interlinked constraints explain this gap including biophysical stress in production systems, inconsistent product quality, misaligned application practices, mechanistic uncertainty, biosafety risk, and weak diagnostic, advisory, and regulatory systems. Overall, FMPs are best understood as preventive and resilience‐building tools rather than direct therapeutic substitutes for antibiotics. Meaningful antibiotic reduction will depend less on product substitution alone and more on integrating these products into stronger health‐management systems supported by quality control (QC), clear deployment protocols, diagnostics, advisory services, and enabling regulation.