Clinical Efficacy of Nanoparticle-Based Antibiotic Delivery Systems in Drug-Resistant Bacterial Infections: A Systematic Review
DOI:
https://doi.org/10.61919/gst14796Keywords:
Antimicrobial resistance; nanoparticles; liposomes; antibiotic delivery systems; multidrug-resistant bacteria; nanomedicine; systematic reviewAbstract
Background: Antimicrobial resistance has substantially reduced the effectiveness of conventional antibiotics against multidrug-resistant bacterial pathogens, creating an urgent need for strategies that improve antimicrobial delivery, efficacy, and tolerability. Nanoparticle-based delivery systems have emerged as a promising approach, but recent translational evidence remains fragmented across preclinical and early clinical studies. Objective: To systematically review recent preclinical and clinical evidence on the efficacy and safety of nanoparticle-based antimicrobial delivery systems in drug-resistant bacterial infections. Methods: A systematic review with narrative synthesis was conducted in accordance with PRISMA 2020. PubMed, Scopus, Web of Science, and CENTRAL were searched for studies published from January 2019 to December 2024. Eligible studies included controlled in vivo animal studies and clinical trials evaluating antimicrobial agents encapsulated, conjugated, or otherwise delivered through nanoparticle systems against drug-resistant bacterial infections. Two reviewers independently screened studies, extracted data, and assessed risk of bias using SYRCLE for animal studies and RoB 2 for randomized trials. Owing to heterogeneity in pathogens, models, formulations, and outcomes, meta-analysis was not performed. Results: Seven studies met the final eligibility criteria, including six murine infection-model studies and one randomized clinical trial. Across the preclinical studies, nanoparticle formulations consistently improved antibacterial efficacy, with bacterial burden reductions ranging from approximately 2 to 4.5 log CFU beyond conventional comparators and survival gains of 20 to 50 percentage points in severe infection models. Liposomal vancomycin, polymeric colistin, solid lipid mupirocin, chitosan-tigecycline, silver nanoparticle-ampicillin conjugates, and liposomal linezolid all showed favorable results. The single clinical trial demonstrated that inhaled liposomal ciprofloxacin significantly prolonged time to first pulmonary exacerbation in adults with chronic Pseudomonas aeruginosa infection (hazard ratio 0.53, 95% confidence interval 0.32-0.88; p=0.01) with acceptable tolerability. Risk of bias was low in the clinical trial but frequently unclear in the preclinical literature because of incomplete reporting. Conclusion: Nanoparticle-based antimicrobial delivery systems demonstrate consistent preclinical efficacy and early clinical promise in resistant bacterial infection, particularly for liposomal platforms. However, the current evidence remains predominantly preclinical, and larger, rigorously designed clinical trials are required before routine clinical adoption can be justified.
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Copyright (c) 2026 Aamnah Aslam, Sahaab Alvi, Anina Qureshi, Adeel Zain, Hina Ali Ahmed, Muhammad Umar (Author)
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