Current Status And Future Direction Of Antibiotics: Therapeutic Potential And Resistance Mechanisms In Bacterial Infections

Abstract

Antibiotics remain fundamental to the treatment of bacterial infections and the safe delivery of modern medical interventions, including surgery, transplantation, intensive care, and cancer chemotherapy. This review synthesizes their therapeutic value, key resistance mechanisms, and strategies required to sustain clinical effectiveness. A structured narrative approach was used to analyze peer-reviewed literature, clinical guidelines, and WHO reports, focusing on antibiotic classes, resistance burden, molecular pathways, One Health drivers, stewardship, and the antibacterial development pipeline. Despite substantial clinical benefits, resistance is increasingly concentrated among WHO priority pathogens, compromising empirical therapy and treatment outcomes. Major resistance mechanisms include enzymatic drug inactivation, target modification, reduced membrane permeability, active efflux, and biofilm-associated tolerance. Sustaining antibiotic efficacy will require coordinated global action, including strengthened stewardship programs, surveillance systems, infection prevention measures, equitable access to effective therapies, and continued innovation in antimicrobial development