Probiotics in the Prevention and Management of Antibiotic-Resistant Infections

Abstract

Antimicrobial resistance (AMR) represents one of the most critical global health threats of the twenty-first century, responsible for more than one million deaths annually and projected to cause ten million by 2050. The overuse and misuse of antibiotics in human medicine, veterinary practice, and agriculture have accelerated the emergence of multidrug-resistant (MDR) pathogens, severely limiting therapeutic options—particularly in intensive care and oncology settings. In this narrative review, we aimed to integrate mechanistic, translational, and clinical evidence on the preventive and therapeutic roles of probiotics in combating antibiotic-resistant infections.Peer-reviewed literature from 2010 to 2025 was analyzed to summarize current knowledge on molecular mechanisms, clinical efficacy, safety, and regulatory frameworks. Probiotics act through multiple complementary pathways, including competitive exclusion of pathogens, production of antimicrobial metabolites, reinforcement of epithelial-barrier integrity, modulation of immune responses, and disruption of biofilm formation. Randomized clinical trials demonstrate that specific strains—such as Saccharomyces boulardii, Lactobacillus rhamnosus GG, and Bifidobacterium longum—reduce the incidence of antibiotic-associated diarrhea, Clostridioides difficile infection, ventilator-associated pneumonia, and urinary tract infections caused by MDR organisms. Meta-analyses further confirm their role in restoring gut microbial diversity following antibiotic therapy.Probiotics, postbiotics, and next-generation microbiome therapeutics hold significant promise as adjunctive strategies within antimicrobial-resistance management. Their integration into One Health-based antimicrobial-stewardship and precision-medicine frameworks may help restore long-term microbiome equilibrium and reduce global antibiotic dependence.