From Polyphenols to β-Lactamases: Multitarget Strategies to Defeat Severe Resistance

TL;DR

This paper reviews strategies combining natural compounds and synthetic inhibitors to combat antibiotic resistance by targeting multiple bacterial mechanisms.

Contribution

The paper provides a comprehensive analysis of multitarget approaches using natural and synthetic agents to overcome severe antimicrobial resistance.

Findings

Natural compounds like polyphenols disrupt bacterial membranes and inhibit efflux pumps.

Synthetic inhibitors target resistance mechanisms such as β-lactamases and quorum sensing.

Combining these agents can restore antibiotic effectiveness without promoting resistance.

Abstract

Antimicrobial resistance (AMR) is one of the most pressing global public health challenges, compromising the effectiveness of standard antibiotic therapies and increasing morbidity, mortality, and healthcare costs. The scarcity of new antibiotics has driven research into alternative strategies to restore or enhance the effectiveness of existing drugs. Natural compounds, including polyphenols, alkaloids, terpenes and terpenoids, antimicrobial peptides, and microbial secondary metabolites, exhibit multitarget activities such as membrane disruption, efflux pump inhibition, biofilm suppression, and quorum sensing interference. In parallel, synthetic and semi-synthetic small-molecule inhibitors have been rationally designed to target specific resistance determinants, including β-lactamases, efflux systems, quorum sensing pathways, and stress-induced mutagenesis mechanisms such as the SOS response and DNA repair processes. These agents act as adjuvants, restoring susceptibility or reducing bacterial virulence without exerting strong selective pressure. The integration of natural bioactive compounds and targeted small-molecule inhibitors represents a promising complementary strategy for conventional antibiotics. Further pharmacological and clinical investigations are required to translate these approaches into effective tools within antimicrobial stewardship programs and broader public health strategies aimed at mitigating the global burden of AMR. This narrative review analyses the recent literature on natural compounds and synthetic or semi-synthetic small-molecule inhibitors with documented activity against antimicrobial resistance mechanisms.

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