Synthetic Antimicrobial Polymers in Combination Therapy: Tackling Antibiotic Resistance

Antibiotic resistance is a critical global healthcare issue that urgently needs new effective solutions. While small molecule antibiotics have been safeguarding us for nearly a century since the discovery of penicillin by Alexander Fleming, the emergence of a new class of antimicrobials in the form of synthetic antimicrobial polymers, which was driven by the advances in controlled polymerization techniques and the desire to mimic naturally occurring antimicrobial peptides, could play a key role in fighting multidrug resistant bacteria in the near future. By harnessing the ability to control chemical and structural properties of polymers almost at will, synthetic antimicrobial polymers can be strategically utilized in combination therapy with various antimicrobial coagents in different formats to yield more potent (synergistic) outcomes. In this review, we present a short summary of the different combination therapies involving synthetic antimicrobial polymers, focusing on their combinations with nitric oxide, antibiotics, essential oils, and metal- and carbon-based inorganics.