Managed colonies of the Western honey bee, Apis mellifera, are essential to global food security by ensuring the pollination of a wide array of crops that are crucial for human consumption. However, substantial declines in managed honey bee populations have been reported worldwide, including in Australia, the United States and Europe. These losses have been attributed to the multifaceted interplay of stressors encompassing agrochemical impact, climate fluctuations, pathogens, suboptimal forage conditions, and habitat reduction. In particular, Paenibacillus larvae, the causative agent of American foulbrood (AFB), is one of the most destructive bacterial pathogens for honey bees due to its high transmissibility, environmental persistence, and capacity to cause complete colony collapse. Recurrent and widespread AFB outbreaks impose significant economic and biosecurity burdens on apiarists, exacerbating declines in pollination services and agricultural productivity. This review synthesises the current landscape of therapeutic strategies targeting AFB, including bacteriophage-based approaches, vaccine development, probiotics, and essential oils, and evaluate their reported field applications, efficacy, and practical limitations. Bacteriophages and immune-priming approaches show the greatest potential to reduce larval mortality and pathogen load, although their application is constrained by formulation stability, delivery challenges, and limited large-scale field validation. Probiotics and essential oils produce highly variable and inconsistent effectiveness under field conditions. Overall, these alternatives currently represent promising complementary tools rather than standalone treatments, underscoring the need for further investigation.