Consumer Perspectives on Antibiotic-Free Animal Products: A Systematic Review Identifying Critical Gaps in Non-Pharmaceutical Intervention Research

<b>Background</b>: The global livestock industry faces pressure to reduce antimicrobial usage while maintaining animal health and productivity. Non-pharmaceutical interventions (NPIs) including probiotics, prebiotics, phytogenics, essential oils, organic acids, and enzymes have emerged as alternatives to antibiotic growth promoters. Commercial success depends on consumer acceptance and willingness to pay (WTP) for products from animals raised using these approaches. <b>Objective</b>: This systematic review synthesized peer-reviewed literature examining consumer knowledge, attitudes, perceptions, and WTP toward animal products produced using NPIs or marketed as antibiotic-free (ABF) to identify a critical gap in existing research. <b>Methods</b>: Following PRISMA 2020 guidelines, four databases (PubMed, Web of Science, Scopus, and Google Scholar) were searched for peer-reviewed studies published from January 2020 to December 2024. Inclusion criteria encompassed original research examining consumer perspectives toward NPIs or antibiotic-free (ABF) animal products. Narrative synthesis was employed due to study heterogeneity. <b>Results</b>: From 847 records, 15 studies met inclusion criteria. A critical finding was that virtually no peer-reviewed research directly examines consumer perceptions of specific NPIs such as probiotics, prebiotics, phytogenics, organic acids, or enzymes as feed additives. The included studies predominantly examined ABF production generally (60%) without specifying alternatives employed. Europe accounted for 80% of studies, while Asia accounted for 20%. Consumer awareness of agricultural antibiotic use was consistently low across contexts. Attitudes toward ABF products were favorable with one study reporting WTP premiums of 18-20%. Health consciousness was the strongest predictor of acceptance. <b>Conclusions</b>: The review highlights that while substantial literature exists on ABF products, no studies examine consumer perceptions of specific non-pharmaceutical interventions. Future research should investigate consumer responses to intervention specific labeling and communication strategies.