Biotics as targeted microbial alternatives to antibiotics in One Health

The global crisis of multidrug-resistant (MDR) bacteria, driven by the overuse and misuse of antibiotics, demands the urgent exploration of effective alternatives. In response, biotics, encompassing probiotics, prebiotics, postbiotics, synbiotics, and bacteriophages—demonstrating 37–40% antibiotic-associated diarrhea (AAD) risk reduction and a 60 - 70% reduction in Clostridioides difficile-associated diarrhea (CDAD) risk reduction—have emerged as a promising and sustainable approach to combat antimicrobial resistance (AMR) by modulating the host-microbiome axis and through competitive exclusion, immunomodulation, and antimicrobial compound production. This review summarizes the current understanding of biotics, focusing on their operational pathways and diverse applications of biotics, particularly within the One Health framework that bridges human, animal, and environmental domains, is crucial. Future research using advanced technologies like Artificial Intelligence (AI) and precision microbiome analysis is expected to unlock the full potential of biotics. This review positions biotics as crucial, targeted, sustainable, and highly effective alternatives to antibiotics while identifying priority areas for future research.