This article explores the roles of probiotics, bacteriophage therapy, &  immunomodulators in enhancing antimicrobial treatment & combating infections. It discusses the mechanisms of action, current research findings, & potential clinical applications of these alternative therapies.

In an era where antibiotic resistance poses a significant threat to global health, alternative therapies have emerged as promising adjuncts in infection management. 

This article aims to explore these alternative approaches, highlighting their mechanisms, efficacy, and potential roles in clinical practice.

1. Probiotics

Mechanism of action

1. Probiotics are live microorganisms that confer health benefits when administered in adequate amounts. They work primarily by modulating the gut microbiota, enhancing the intestinal barrier function, and competing with pathogenic microorganisms for resources.
2. Probiotics also exert immunomodulatory effects by stimulating the production of secretory IgA and enhancing the activity of innate immune cells [8].

Clinical applications

Several studies have shown that probiotics can reduce the incidence and duration of antibiotic-associated diarrhoea [6]. Furthermore, they have been investigated in the context of various infectious diseases, including Clostridium difficile infection and respiratory infections. While more high-quality randomised controlled trials are needed, the existing evidence supports the integration of probiotics into infection management protocols.

2. Bacteriophage therapy

Mechanism of action

1. Bacteriophage therapy utilises viruses that specifically infect and lyse bacterial cells, offering a targeted approach to combat bacterial infections [1].
2. Bacteriophages can replicate within the bacterial host, leading to bacterial cell death while sparing human cells. This specificity reduces the risk of disrupting beneficial microbiota and minimises the development of resistance.

Clinical applications

1. Research into bacteriophage therapy is expanding, with notable success in treating multidrug-resistant bacterial infections, particularly in cases of chronic wounds, cystic fibrosis, and certain enteric infections [4].
2. In clinical trials, patients have experienced improved outcomes when phage therapy was used as an adjunct to antibiotics, particularly in cases involving antibiotic-resistant organisms [5].

3. Immunomodulators

Mechanism of action

1. Immunomodulators are agents that modify the immune response, enhancing the body's ability to combat infections. They may promote a more robust adaptive immune response or modulate excessive inflammation [3].
2. Substances like cytokines, monoclonal antibodies, and small molecules are utilised to achieve these effects.

Clinical applications

1. Immunomodulators are increasingly examined for their role in treating infectious diseases. For example, interferon therapies have been used to treat chronic viral infections, while monoclonal antibodies have shown promise in managing respiratory infections, such as RSV (respiratory syncytial virus) [2].
2. The potential to use immunomodulators in conjunction with traditional antibiotics to enhance efficacy against resistant organisms is an area of ongoing research.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Partha Ghosh, BNYS, MD(YS), is a general physician and a medical writer from Siliguri, Darjeeling.