Natural Herbal Drugs in Multidrug-Resistant, Extensively Drug-Resistant and Totally Drug-Resistant Bacterial Infection: A Comprehensive Review on Medicinal Plants

Abstract

The alarming rise of multidrug-resistant (MDR), extensively drug-resistant (XDR) and totally drug-resistant (TDR) bacterial pathogens poses a critical challenge to global public health, rendering many conventional antibiotics increasingly ineffective. The accelerated emergence of these resistance profiles has led to treatment failures; prolonged hospital stays and increased mortality rates. In this dire scenario, medicinal plants represent a promising, cost-effective and sustainable alternative for the discovery of novel antimicrobial agents with unique mechanisms of action. This comprehensive review highlights a diverse array of medicinal plants and their phytoconstituents that exhibit significant antibacterial activity against drug-resistant pathogens. Emphasis is placed on traditional ethnobotanical knowledge, the pharmacological efficacy of plant-based compounds and their molecular mechanisms, such as inhibition of cell wall synthesis, efflux pumps, biofilm formation and quorum sensing. Furthermore, the review explores the synergistic potential of herbal agents with existing antibiotics, current research progress, formulation advancements and the challenges hindering clinical translation. By bridging traditional medicine with modern scientific validation, herbal antimicrobials could contribute substantially to combating the growing threat of antimicrobial resistance (AMR).