The pandemic of antimicrobial resistance with the paucity of new classes of antibiotics is one of the global threats warranting immediately actionable strategies. The widespread and inappropriate use of broad-spectrum and last-resort antibiotics during the first, second and third waves of the COVID-19 pandemic require a multidisciplinary approach to address this issue. The current pipeline has only 43 antibiotic candidates targeting the WHO priority pathogens and the majority are modifications of previously known classes with already existing cross-resistance. Preserving the power of existing antibiotics by their regulated use and prevention of the spread of pathogens through infection prevention and control seems the only possible solution to defer the AMR crisis. Meanwhile, numerous alternative avenues are present like antimicrobial peptides, phage therapy, probiotics, prebiotics and synbiotics, eligo-biotics, phage-endolysins, anti-virulence therapy, targeting pattern recognition receptors, phytochemicals, antimicrobial enzymes CRISPR-Cas mediated gene disruption, efflux pump inhibitor, vaccines, monoclonal and polyclonal antibodies are currently available to fight antibiotics resistance and reduce dependence on antibiotics. These alternatives must satisfy the criteria for safety, efficacy and affordability for translation in clinical use. This review provides an overview of various promising, potential and under investigative strategies, as alternatives to antibiotics, their mechanism of action, current status, challenges in their commercialization and future scope. Keywords: COVID-19, antimicrobial resistance, antibiotics, antibiotics alternatives.

Insulin is the cornerstone of type 1 diabetes therapy and a critical addition for type 2 diabetes control. Despite significant advancements in insulin therapy research, including the creation of innovative insulin formulations and delivery systems, there are still numerous difficulties and unknowns surrounding insulin therapy. The main issues with more recent pharmacological and technological methods are biocompatibility, degradation/clearance of delivery materials, immunogenicity, stability, the precision of dosing, reproducibility of an effect similar to that of endogenous insulin, predictability of performance, and safety over time. In order to achieve a protracted, flatter profile, with fewer instances of hypoglycemia and an improvement in postprandial glucose level, more recent insulin mutants were developed. The "meal" (glucose-responsive) insulins, which are supplied in accordance with an endogenous glucose-sensing feedback mechanism, best represent the future generation of insulin treatment. Insulin delivery methods with novel jet injectors, smart pens, patch pumps, and other needle-free tools for subcutaneous doses are another area of ongoing advancements. Digital health has significantly advanced treatments in recent years. As such, insulin treatments should become more scalable and potentially more cost-effective.

In the present systematic review and meta-analysis, the authors analysed case reports of drug-induced thrombocytopenia/drug-induced thrombocytopenic purpura (DITP) and its mechanisms. The search included electronic databases for case reports of DITP using specific keywords in MEDLINE via PubMed, PubMed Central, and Embase. All case reports were designated a score/criteria (definite, probable, or possible). The mechanism of DITP was also analysed in each case report. A total of 751 case reports were included in the meta-analysis. The incidences for all-score DITP by random and common effect models were 0.65% (95% confidence interval: 0.61–0.69) and, 0.65% (95% confidence interval: 0.62–0.68), respectively. The number of DITPs with scores of 1, 2, and 3 was found in 151, 300, and 300 patients, respectively. Amongst the drugs, the maximum number of DITPs were caused by antibiotics, antimalarials, monoclonal antibodies, antiplatelet drugs, disease-modifying antirheumatic drugs, anti-epileptics, anti-cancer chemotherapeutics, and non-steroidal anti-inflammatory drugs. Out of 751 cases, 478 patients were hospitalised, and 323 patients had external or internal bleeding, including 62 patients who had major bleeding intracranially or retroperitoneally and required transfusion of two or more units of red blood cells. Mortality occurred in 12 patients. Clinicians should be aware of the potential of drugs causing DITP as an important adverse event, as it may affect patient compliance and adherence to drugs. Unrecognised DITP may lead to severe thrombocytopenia and inappropriate patient management.