Coccidiosis is a self-limiting disease that is universally present in poultry operations, causing extensive damage to the intestinal lining of the bird. Global economic losses from coccidiosis are estimated to be $3 billion per year. In-feed anticoccidial use has been the predominant form of coccidiosis control. However, due to widespread emergence of antimicrobial resistance, concerns have been raised regarding the safety of anticoccidials and the potential impact on human, animal, and environmental health. To investigate the benefits, risks, and alternatives to anticoccidial use, a comprehensive review of recent literature was conducted. Several live vaccines are available, which, when used in combination with anticoccidials, have been shown to help restore sensitivity of infective parasites. However, their use has been limited because of increased cost; increased susceptibility to bacterial enteritis; challenges with consistent application; and slow development of immunity. Various alternative feed products are available, but do not have a direct anticoccidial effect, and few studies have demonstrated consistent field efficacy of these products. Consumer and environmental safety of anticoccidials is monitored and assessed by governing bodies. Furthermore, there is a lack of current evidence to indicate that bacterial resistance poses a public health concern. The findings from this review indicate that in the absence of alternatives, poultry production is optimized by using anticoccidials, benefiting all three pillars of sustainability, including social (bird health, welfare, and food safety), economic (production efficiency), and environmental aspects.
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