Combination therapy: herbal products with antibiotics in combating bacterial resistance – a mini-review of the literature
December 17, 2025
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| Article Title: | Combination therapy: herbal products with antibiotics in combating bacterial resistance – a mini-review of the literature |
| Authors: | Mureșan M.L., Virchea L.-I., Cormoș G., Muntean A.C., Crăciunaș M.-T., Gligor F.-G., Chișe E. |
| Affiliation: | Faculty of Medicine, ”Lucian Blaga” University of Sibiu, A Lucian Blaga Street, 550169, Sibiu, Romania Faculty of Sciences, “Lucian Blaga” University of Sibiu, Dr. Ion Rațiu Str. 5-7, 550012, Sibiu, Romania Faculty of Pharmacy, ”Vasile Goldiș” Western University of Arad, L. Rebreanu Str. 86, 310414, Arad, Romania |
| Abstract: | The use of antibiotics is crucial in combating bacterial infections and has had a significant impact on the health-related quality of human life since their introduction. Over the past few decades, many commonly used antibiotics have become less effective due to the emergence of drug-resistant bacteria, creating a significant global public health concern. An alternative approach to treating infectious diseases involves using plant extracts individually or in combination with antibiotics. Thus, this review aims to emphasize, through a study of the current literature, the role of synergistic action between plant products and antibiotics in combating bacterial resistance. PubMed and Google Scholar are used as the search engines, and the latest studies are considered. The main classes of compounds with antimicrobial activity include flavonoids, isoquinoline alkaloids, terpenoids, volatile oils, and polyphenols. They target multiple bacterial processes, including protein synthesis, cell wall integrity, deoxyribonucleic acid (DNA) replication, metabolic pathways, efflux pump activity, and cell viability. Research from 2001 to 2024 demonstrates that phytochemicals can reduce antibiotic minimum inhibitory concentrations (MICs) by 0.25 μg/mL to 63.4 μg/mL-fold against World Health Organization (WHO) priority pathogens, with fractional inhibitory concentration (FIC) indices as low as 0.03-0.5. Despite robust preclinical evidence, significant bioavailability challenges and the absence of large-scale clinical trials remain barriers to clinical translation. |
| Keywords: | plant products, antibiotics, drug-resistant bacteria, synergism, bioactive compounds, efflux pump. |
| *Correspondence: | Mureșan Maria Lucia, ˝Lucian Blaga ˝University, Faculty of Medicine, Preclinical Department, 2A Lucian Blaga Street, 550169, Sibiu, Romania, email: maria.muresan@ulbsibiu.ro |
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