Horses play an important role in many human activities. However, they are susceptible to bacterial infections, which may seriously impact their health and activity. These diseases are treated by using antibiotics. However, the increasing frequency of antibiotic resistance poses a significant concern since it reduces the efficacy of current therapies, resulting in extended illness, increased veterinary costs, higher fatality rates and potentially threat to human health through zoonotic transmissions. Consequentially, there is a growing interest in developing alternative medicines for tackling bacterial infections in horses. These alternatives include the use of bacteriophage, antimicrobial peptides, and nanoparticles. Integrating alternative therapies into veterinary practices may also assist in reducing antibiotic dependency and maintaining the efficacy of current antibiotics for future generations. Such treatments are intended to provide effective infection control while reducing the potential for antibiotic resistance. This review outlined the multidrug-resistant (MDR) pathogens causing different diseases in equine globally, the efficacy, advantages, applications, and limitations of innovative, emerging, or developing therapies currently under investigation that may offer potential solutions to combat MDR bacteria in equine. Ongoing research and innovation in this field of study are essential for maintaining long-term horse health management and tackling the broader effects on both animal and human health.