TABLE 1.

The advantages, disadvantages and future direction/ implementations for microbiome‐based therapeutics

Therapeutic	Advantages	Disadvantages	Future directions/implications
Dietary interventions	• Safe • Easily manipulated	• Variable components in each food item • Insufficient dose for therapeutic benefit • Temporary therapeutic response	Further work required to identify key components of diet that can be altered to allow for a therapeutic response
Prebiotics	• Safe • Components of food • Easily administered	• Dependent on specific microbe colonisation • Dependent on gut microenvironment • Therapeutic response temporary • Potential adverse responses (e.g. bloating)	Potential in prevention of paediatric immune diseases (e.g. respiratory disease and allergy). Prebiotics should be examined for their treatment of other conditions
Probiotics	• Relatively safe • Readily available as standardised mix	• Not targeted to a disease or patient • Dependent on specific microbe colonisation • Dependent on gut microenvironment • Therapeutic response temporary • Viability not requirement of regulator	Efficacious following antibiotics and in the prevention of NEC. Potential as non‐specific treatments to increase bacterial diversity
Synbiotics	• Relatively safe • Includes all components for efficacy	• Therapeutic response temporary • Require a specific gut microenvironment • Potential adverse responses (e.g. post antibiotics)	Efficacious in the treatment of metabolic diseases. Further combinations should be explored for the treatment of other diseases
Antibiotics	• Safe • Cheap • Approved medication • Existing regulatory framework	• Potential off‐target effects (antibiotic resistance, disruption of colonisation resistance) • Limited to disruption of the microbiota	Examination for use in targeted microbiome manipulation; however, caution is required to avoid off‐target, adverse effects
Phage therapy	• Highly specific	• Limited to disruption of the microbiota • Targets require specific development • Emerging therapy	Examination for use in altering microbiome structure due to their highly specific nature
FMT	• Contains all microbes and nutrients • Proven efficacious for Clostridioides difficile treatment	• Donor variability • Requires rigorous pre‐screening • Efficacy only seen for some conditions • Some administration costly • Inability to standardise composition	Further work is required to determine causality in FMT treatment. This will allow for FMT to be considered for the treatment of other diseases
Live biotherapeutics	• Approved for specific indications	• Requires maintenance of bacterial viability • Potential adverse long‐term health effects • Difficulty determining causal relationship	Determination of causality required to allow for development
Microbiome mimetics	• Not reliant on current microbiome state	• Limited research to develop mimetics	More research required to identify candidates as mimetics and mechanisms of delivery, including diet should be explored

Abbreviations: FMT, faecal microbiota transplant; NEC, necrotising enterocolitis.