EMERGING STRATEGIES AGAINST ANTIMICROBIAL RESISTANCE: PHAGE THERAPY, ANTIMICROBIAL PEPTIDES, AND ANTIBIOTIC ADJUVANTS

Antimicrobial resistance is a global health crisis that threatens the efficacy of existing antibiotics and undermines modern medicine. The pipeline of new conventional antibiotics is insufficient to meet the growing burden of resistant infections, prompting urgent interest in alternative and adjunctive strategies. This review critically examines three emerging approaches: bacteriophage therapy, antimicrobial peptides, and antibiotic adjuvants. Phage therapy exploits naturally occurring viruses that specifically infect and lyse bacteria, offering high specificity and the ability to co-evolve with resistant pathogens. Clinical evidence from compassionate use, case series, and early trials suggests efficacy in difficult-to-treat infections, but standardized manufacturing, regulatory frameworks, and pharmacokinetics remain challenging. Antimicrobial peptides are host-defense-inspired molecules with broad-spectrum activity and lower propensity for resistance, yet their clinical translation has been limited by stability, toxicity, and cost. Antibiotic adjuvants aim to restore the activity of existing antibiotics by inhibiting resistance mechanisms such as β-lactamases, efflux pumps, or biofilm formation, with several β-lactamase inhibitor combinations already in clinical use. The review compares these strategies, highlights their limitations, and discusses combination approaches that may enhance efficacy while minimizing resistance development. Future directions include engineered phages, peptide mimetics, and novel adjuvants targeting emerging resistance determinants. A coordinated, multidisciplinary effort will be essential to translate these innovations into clinical practice.