ANTIBIOFILM AGENTS IN THE FIGHT AGAINST PERSISTENT INFECTIONS, A NARRATIVE REVIEW

Abstract

The formation of microbial biofilms constitutes one of the major contemporary challenges in the management of persistent and healthcare-associated infections, being directly associated with increased antimicrobial resistance, recurrent infections, and therapeutic failures observed in clinical practice. Biofilms are highly organized microbial communities adhered to biotic or abiotic surfaces and embedded within a complex polymeric extracellular matrix, which provides both physical and functional protection against antimicrobial agents and the host immune response. This structural organization favors microbial survival in hostile environments and significantly contributes to the chronicity of infections. Consequently, treatments based exclusively on antibiotics often require high doses and prolonged regimens, increasing the risk of systemic toxicity and the selection of multidrug-resistant strains. In light of these limitations, several strategies have been investigated with the aim of preventing biofilm formation, promoting biofilm dispersion, or enabling the eradication of mature biofilms. This narrative review critically and integratively discusses the main agents used to combat microbial biofilms, including conventional antibiotics, antiseptics and disinfectants, chelating agents and extracellular matrix disruptors, natural compounds, antimicrobial peptides, matrix-degrading enzymes, and nanotechnology-based approaches. The mechanisms of action of these agents, as well as their advantages, limitations, and synergistic potential when employed in combination therapies, are addressed.