Gut Check Time: Antibiotic Delivery Strategies to Reduce Antimicrobial Resistance

Antimicrobial resistance (AMR) has developed into a huge threat to global health, and reducing it is an urgent priority for public health authorities. The importance of a healthy and balanced gut microbiome has been identified as a key protective factor against AMR development, but this can be significantly affected by antibiotic therapy, resulting in dysbiosis and reduction of taxonomic richness. The way in which antibiotics are administered could form an important part of future antimicrobial stewardship strategies, where drug delivery is ideally placed to play a key role in the fight against AMR. This review focuses on drug delivery strategies for antibiotic administration, including avoidance of the gut microbiome and targeted delivery approaches, which may reduce AMR. Avoiding antibiotic exposure of the gut microbiota may help to reduce the enrichment for antimicrobial resistance genes and the subsequent emergence of antimicrobial resistance.Drug delivery modality should be considered in any antimicrobial resistance stewardship strategy, and formulation, route of administration, and targeted antibiotic delivery all play key roles.The use of nanoparticle-based formulations for antibiotic delivery has resulted in increased efficacy against intracellular pathogens compared with free drug, as well as reductions in effective antibiotic doses.Novel and emerging drug delivery technologies, including molecularly imprinted polymers and enhanced transdermal delivery platforms such as microneedles, could be employed in targeted antibiotic delivery systems.