Antimicrobial resistance (AMR) has emerged as a critical global health concern that transcends human, animal, and environmental boundaries. The extensive and often indiscriminate use of antibiotics for disease control and growth promotion has accelerated the evolution and spread of resistant pathogens within the aquaculture sector. This review examines aquaculture-associated AMR through a One Health framework. We explore the molecular mechanisms of resistance such as efflux pumps, enzymatic degradation, mobile genetic elements, and horizontal gene transfer that drive the dissemination of antimicrobial resistance genes among aquatic microorganisms. The review synthesizes evidence linking AMR in aquaculture to public health impacts, including the transmission of resistant bacteria through seafood and environmental exposure. Current regulatory measures and stewardship policies are assessed to identify gaps in implementation, particularly in developing regions where enforcement and public awareness remain limited. Review highlights emerging alternatives such as bacteriophage therapy, engineered probiotics, synthetic microbial communities, and CRISPR-based systems as sustainable approaches to reduce antibiotic dependence. Future research priorities include the integration of genomics, artificial intelligence, and environmental DNA monitoring for precision surveillance. This review emphasis the need for cross-sectoral collaboration, innovation, and global policy coherence to mitigate AMR in aquaculture and safeguard food, environmental, and public health security.