Microbiome biotherapeutics range from standardized indication-specific products to donor-, recipient- and ecology-informed interventions.

To evaluate the clinical efficacy, safety, and reproducibility of microbiome biotherapeutics and determine how donor, product, recipient, and longitudinal multi-omics characteristics have been used to personalize treatment.

PubMed/MEDLINE, Cochrane CENTRAL, and ClinicalTrials.gov were searched from inception to 8 July 2026, supplemented by regulatory sources, publisher searches, and citation tracking.

Twenty-seven unique studies represented by 28 eligible reports were included across recurrent CDI, oncology and immunotherapy, ulcerative colitis, and MDRO decolonization.

Current routine evidence is strongest for standardized microbiota-based prevention of recurrent CDI after antibacterial therapy. Validated patient-level personalization is not yet established.