Nanotechnology-Based Antimicrobial Strategies: A Review

Abstract

Emergence of antimicrobial resistance has called for the search for alternative and complementary antimicrobial treatment strategies beyond traditional approaches, where nanotechnology holds promise for better prevention and management of infectious diseases. This review provides a critical analysis of human clinical and human-relevant evidence of antimicrobial nanotechnology applications, including silver nanoparticles, nanocrystalline silver, nano-enabled wound dressings, nanoparticle-mediated antimicrobial drug delivery, nanofibers, nanocomposites, antimicrobial coatings, and applications in medical devices. Evidence from human clinical studies indicates that nanomaterials based on silver have demonstrated encouraging results in specific wound and burn indications in terms of bacterial removal and healing, while there were some reports showing results no better than those obtained using conventional antibiotics. In addition to antibacterial activity, nano-enabled wound dressings can potentially provide localized action, protection of the wounds, controlled drug release, and other patient benefits, whereas nanoparticle-mediated drug delivery and antimicrobial coatings are novel clinical applications. Nevertheless, the evidence is highly heterogeneous, with major limitations associated with the low number of large multicenter human studies, the variety of the characteristics and formulations of nanoparticles, long-term safety, standardization, manufacturing processes, regulatory requirements, cost-effectiveness, and possible microbial adaptation. It should be noted that at the current stage of development nanotechnology has the most promising clinical applications in localized applications, such as wound and burn management. Systemic applications, targeted and advanced biofilm removal remain to be confirmed through additional human clinical studies. Future research is expected to include large-scale randomized clinical trials, nanoparticle characterization, long-term safety assessment, monitoring of antimicrobial resistance, patient benefits, and cost-effectiveness analysis of antimicrobial nanotechnology.