Antibacterial sonodynamic nanomedicine: mechanism, category, and applications

Sonodynamic therapy (SDT) has emerged as a cutting-edge strategy for combating multidrug-resistant bacterial infections. Unlike conventional antibiotics, SDT leverages the generation of reactive oxygen species during the treatment process to inflict multifaceted damage on bacterial cells, thereby significantly reducing the likelihood of developing drug resistance. Compared to other physical sterilisation methods, such as ultraviolet irradiation, SDT offers enhanced tissue penetration, making it particularly suitable for addressing deep-seated infections, including osteomyelitis. Despite its significant advantages, the clinical translation of SDT for antibacterial applications faces several challenges. This review discusses the fundamental mechanisms of SDT, with a focus on phenomena such as cavitation-induced reactions and piezocatalytic generation of reactive oxygen species. Furthermore, it provides a comprehensive analysis of various sonosensitisers used in SDT, emphasising their potential to enhance therapeutic outcomes in areas such as infected wound healing, bone regeneration, and the mitigation of deep tissue inflammation. While SDT shows great promise in addressing multidrug-resistant bacterial infections, further research and development are essential to overcome existing limitations and unlock its full clinical potential.