Antimicrobials are the keystone of therapy for bacterial infectious diseases. The One Health approach recognizes that the health of humans, animals, and the environment are intricately connected, where the use of antimicrobials in animals select for resistant bacteria which carries resistant genetic elements that can be transmitted from animals to humans. Therefore, antimicrobials use should be limited to treat sick animals. The removal of antimicrobials as growth promoters from animal diets is a growing and irreversible process that led to develop, select, and use cost and effective alternatives in poultry production. The most popular alternatives widely used in several regions of the world include metals, enzymes, organic acids, probiotics, prebiotics, synbiotics, phytochemicals and combinations of them. The expected outcomes in health and productive performances of poultry chickens can be achieved if those antimicrobial alternatives are able to control some factors that influence gut health and productivity. The present review focuses on the impact of most widespread alternatives used for growth promotion on microbiota, immune system, and oxidative status.