Breaking barriers in antimicrobial therapy: resistance mechanisms and novel antimicrobial strategies

Modern healthcare systems face significant challenges from antimicrobial resistance (AMR), which threatens our ability to effectively manage infectious diseases. The widespread prevalence of AMR and its constantly evolving patterns define its epidemiological landscape, with multidrug-resistant organisms emerging at an alarming rate.

A thorough examination of the literature was conducted using multiple databases, including Google Scholar, PubMed, Science Direct, and Springer Link. The search included keywords such as "antimicrobial resistance," "causes and mechanisms of antimicrobial resistance," "strategies to overcome antimicrobial resistance," "coordinated global action to address antimicrobial resistance," and "novel approaches to combat antimicrobial resistance."

This review investigates the causes and mechanisms of AMR, including restricted drug uptake, modifications and inactivation of drug targets, drug efflux, enzymatic changes, and alterations in metabolic pathways, biofilm formation, and horizontal gene transfer. These mechanisms drive the emergence and spread of resistant strains. Mitigation strategies emphasize the importance of continuous monitoring and rational antimicrobial use. In addition, novel therapeutic innovations such as antimicrobial peptides, nanotechnology-based systems, and metal-based compounds exhibiting multi-target mechanisms including ROS generation, enzyme inhibition, and membrane disruption, present promising opportunities to counter AMR.

This review summarizes drug development approaches designed to address antimicrobial resistant organisms, supporting stewardship efforts and guiding future research toward innovative strategies.