Table.
Uses of alternatives to antibiotics for health promotion, prophylactic and therapeutic purposes in humans, animals and food preservation*
| Substitute | Human use | Animal use | Food | Major strength | Major limitations | ||||
|---|---|---|---|---|---|---|---|---|---|
|
|
|
|
|||||||
| Promotion$ | Prophylactic | Therapeutic | Promotion | Prophylactic | Therapeutic | Preservation/disinfection | |||
| Vaccines | X |
|
X | X |
|
X | X | Specific, efficient immune response with memory | Reversion to virulence, no/limited cross-protection, parenteral route |
| Polyclonal antibody | X |
|
|
X |
|
|
X | Immediate response for fatal infections | Supply chain issues |
| Monoclonal antibody | X |
|
|
X | ? | ? | X | -do- | Need for diagnosis/pathogen escape |
| Pattern recognition receptors | X |
|
X | X | ? | X | X | Increase immunogenicity of antigens | - |
| Antimicrobial peptides# | X | ? |
|
|
|
|
|
Broad-spectrum, target MDR pathogens | Resistance, toxicity |
| Probiotics |
|
|
|
|
|
|
? | Safe, multiple mechanisms of action | Standardization of dose, strain |
| Bacteriophages and lysins | X |
|
|
X |
|
|
|
High specificity, ease of administration | Integration in host genome, unstable |
| Phytochemicals |
|
|
? |
|
|
|
? | Immunomodulation | Poorly standardized products/toxicity |
| Antimicrobial enzymes |
|
? | ? |
|
|
? |
|
Specificity and strong catalytic activity | Denaturation, loss of activity |
| Heavy metals |
|
|
? |
|
|
|
|
Target multiple cellular processes | Metal toxicity, resistance |
| Nanomaterials | ? | ? | ? | ? | ? | ? |
|
Improved pharmacokinetics | Toxicity |
| CRISPR/Cas | ? | ? | ? | ? | ? | ? | ? | Re-sensitization of bacteria to antibiotics | Delivery option, target mutation |
| Predatory bacteria | ? | ? | ? | ? | ? | ? | ? | Potential for resistance rare | Risk of gut microbiome alteration |
*Efficacy varies with host species and reasons of use; Promising strategies (evidence of efficacy in systemic review, meta-analysis or review of authoritative organizations (WHO, FAO), commercially available; Potential strategies (scientific evidence of usefulness available but not sufficient to justify large scale commercial use/market approvals); $Efficacy in direct health promotion not by prevention of infections; #Many AMPs such as colistin banned for animal use to save them for human use; ? Investigational strategies (approaches in pre-clinical/clinical research); X No efficacy. CRISPR/Cas, clustered regularly interspaced short palindromic repeats/CRISPR-associated; AMPs, associated molecular patterns