A narrative review published in Discover Molecules on 30 June 2026 argues that a broad family of biological products, collectively called biotics, could serve as targeted and sustainable alternatives to conventional antibiotics in the fight against antimicrobial resistance. The review, authored by Ahmed Dewan, synthesizes existing evidence on probiotics, prebiotics, postbiotics, synbiotics and bacteriophages, and frames them within the One Health approach that links human, animal and environmental health. As a narrative review, it aggregates and interprets prior research rather than reporting new clinical trial data, but the figures it compiles are striking: antibiotic-associated diarrhea risk reductions of 37 to 40 percent and reductions of 60 to 70 percent in the risk of Clostridioides difficile-associated diarrhea when probiotics are co-administered with antibiotics.
The urgency behind the review stems from the global crisis of multidrug-resistant bacteria, which the author attributes to the overuse and misuse of antibiotics in both clinical and agricultural settings. Citing earlier estimates, the review notes that antimicrobial resistance-associated infections were projected to cause 10 million deaths annually by 2050 unless global action addresses the crisis. The One Health framework underscores why the problem resists simple fixes: antibiotics used in livestock select for resistant bacteria that can transfer resistance genes across species and ecosystems, amplifying risks well beyond hospitals and clinics.
Biotics differ from broad-spectrum antibiotics in how they act. Rather than indiscriminately killing bacteria, they operate through ecological pathways: competitive exclusion of pathogens, stimulation of antimicrobial peptides, reinforcement of epithelial barriers, and reprogramming of gut metabolism. Because these mechanisms avoid the strong selective pressure that drives resistance evolution, the review positions them as inherently more sustainable. Their applicability spans human medicine, veterinary practice, aquaculture and environmental stewardship, which aligns naturally with the One Health principle that human, animal and ecosystem health are interconnected.
The review organizes biotics into distinct categories with precise definitions. Probiotics are live microorganisms that confer a health benefit when administered in adequate amounts, including strains of Lactobacillus and Bifidobacterium, certain Bacillus, Enterococcus and Streptococcus strains, and yeasts such as Saccharomyces boulardii. Prebiotics are substrates selectively utilized by host microorganisms, encompassing inulin, fructo-oligosaccharides, galacto-oligosaccharides and some resistant starches. Synbiotics combine the two, with recent consensus distinguishing synergistic formulations, in which the prebiotic feeds the co-administered probiotic, from complementary ones, in which each component acts independently. Postbiotics are preparations of non-living microbes or their constituents, appealing where live organisms pose safety or stability concerns because they allow standardization and storage without risks of translocation or unintended colonization.
Bacteriophages occupy a special place in this landscape. These viruses specifically target and lyse bacterial cells, offering a precision that broad-spectrum antibiotics lack. The review highlights evidence that combining phage cocktails with probiotics or Actinobacteria such as Streptomyces and Nocardioides can enhance pathogen suppression by triggering resident microbes as a secondary defense line. In poultry production, a basal diet supplemented with 0.1 percent phage cocktail combined with 0.1 percent probiotics significantly enhanced growth performance and positively modulated gut microbiota in broiler chickens, outperforming single-agent treatments. In plant protection, phage cocktails combined with Nocardioides or Streptomyces strains improved protection by an average of 79 percent and 72 percent, respectively.
Mechanistically, the review describes how biotics diminish pathogen load, enhance host defenses and reduce the need for antibiotics through multiple pathways. Several probiotics produce antimicrobial compounds, including organic acids, short-chain fatty acids such as acetate, propionate and butyrate, bacteriocins, and hydrogen peroxide, which can disrupt pathogen cell membranes, interfere with cell wall formation or block critical enzymes. Prebiotic fermentation yields short-chain fatty acids that bind G-protein-coupled receptors on enteroendocrine cells, triggering release of the metabolic hormones GLP-1 and PYY. Probiotics also support the intestinal epithelial barrier by increasing mucin expression and enhancing tight junction proteins, and certain strains, such as Lactobacillus reuteri, modulate immune responses by inhibiting pro-inflammatory cytokines while promoting secretory IgA secretion.
The translational evidence is strongest in gastrointestinal medicine. A meta-analysis of 82 randomized controlled trials evaluating various probiotics for the prevention or treatment of antibiotic-associated diarrhea suggested significant risk reduction, although direct comparisons between strains failed to identify a clearly superior intervention. An analysis of 39 randomized trials involving 9,955 participants found that co-administering probiotics with antibiotics reduced the risk of Clostridioides difficile-associated diarrhea by an average of 60 percent, with reductions of up to 70 percent in high-risk populations. Adjunctive treatment with Lactobacillus rhamnosus GG alongside standard rehydration significantly decreased the duration of acute infectious diarrhea in children by roughly 20 hours relative to control groups. Beyond the gut, probiotics reduced the incidence of respiratory tract infections in an examination of 23 studies involving 6,269 children, and specific strains have been shown to enhance antibody levels and seroconversion rates after vaccination.
In animal health, the review reports that biotics are extensively used in livestock, aquaculture and companion animals to enhance health and performance while diminishing dependence on antibiotics. Analyses cited in the review found that probiotic and prebiotic administration substantially increased beneficial bacteria across livestock species, with poultry exhibiting the most significant increases in Lactobacillus, at 35 percent, and Bifidobacterium, at 30 percent. In aquaculture, biotic supplements reduce pathogenic diseases, promote growth and survival, and enhance fertility and hatching rates, although some studies showed no significant effect, a variability attributed to strain viability in aquatic environments, feed composition, species-specific gut microbiomes and dosing regimens. In cats and dogs, specific probiotics enhance the management of acute and chronic diarrhea and inflammatory bowel disease, while evidence in horses remains more inconsistent, underscoring the need for species- and condition-specific assessments.
The review is candid about the obstacles that hinder broader adoption. Probiotic effects are highly strain-specific rather than species-specific, so data from one product cannot be reliably extrapolated to another formulation. Host-specific factors such as diet, genetics, age and baseline microbial population create distinct responder and non-responder phenotypes, making clinical results difficult to generalize. Many commercial probiotic products fail to retain their minimum specified viable cell count through the end of shelf life, and the microorganisms are sensitive to light, oxygen and moisture, requiring rigorous cold-chain logistics. Even after ingestion, probiotics must survive gastric acidity and bile salts to reach the colon in sufficient numbers. The regulatory landscape is fragmented: the European Food Safety Authority maintains strict guidelines and a Qualified Presumption of Safety positive list, while the United States Food and Drug Administration regulates many biotics as dietary supplements under a GRAS process that can leave regulatory data gaps. Clinical guidance is also divided, with the American Gastroenterological Association suggesting probiotics may reduce antibiotic-induced C. difficile-associated diarrhea while the American College of Gastroenterology advises against their use for this purpose.
Looking forward, the review identifies artificial intelligence and precision microbiome analysis as technologies expected to unlock the full potential of biotics. AI-driven platforms accelerate high-throughput strain screening and predictive consortia assembly, and the iProbiotics platform is cited as an example of rapidly predicting probiotic functionality from whole-genome sequences to enable personalized consortia. Next-generation biotics derived from commensal species not traditionally found in food, such as Akkermansia muciniphila and Faecalibacterium prausnitzii, and engineered probiotics modified through gene editing, are expanding the field toward targeted, personalized biological therapies. The author concludes that biotics represent a scientifically mature and mechanistically diverse strategy for antimicrobial stewardship, but cautions that future efforts should prioritize large-scale, strain-specific clinical trials and global regulatory alignment before they can become a fundamental pillar of modern antimicrobial practice.
Subject of Research: Biotics as microbial alternatives to antibiotics within the One Health framework
Article Title: Biotics as targeted microbial alternatives to antibiotics in One Health
Article References: Dewan, A. (2026). Biotics as targeted microbial alternatives to antibiotics in One Health. Discover Molecules, 3(1), Article 19. https://doi.org/10.1007/s44345-026-00055-x
Image Credits: AI Generated
DOI: 10.1007/s44345-026-00055-x
Keywords: antimicrobial resistance, probiotics, prebiotics, postbiotics, synbiotics, bacteriophages, One Health, microbiome, antibiotic-associated diarrhea, Clostridioides difficile, livestock, artificial intelligence
News Source: Morgan Morrow. (October 30, 2026). Review maps biotics as targeted microbial alternatives to antibiotics. Scienmag.
