{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:03:04Z","timestamp":1792065784291,"version":"4.4.0"},"reference-count":219,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceutics"],"abstract":"<jats:p>Antimicrobial resistance (AMR) presents a global health challenge that is projected to cause nearly 2 million deaths annually by 2050. With a growing ageing population and the rise of antibiotic-resistant strains globally, developing effective alternatives to combat infections while reducing AMR risks is critical. Over recent decades, antibiotic-free strategies have emerged as promising approaches, offering advantages over traditional antibiotics and reducing the likelihood of resistance. This review highlights antibiotic-free antimicrobial strategies for applications in chronic wound care, hard tissue repair, personal protective equipment, as well as hospital hygiene and infection control. We begin by outlining the broader AMR problem and then examine natural strategies\u2014including the use of agents such as manuka honey\u2014followed by synthetic approaches involving nanomaterials and metal\u2013organic frameworks (MOFs), as well as biological and bioinspired antimicrobial strategies, involving antimicrobial peptides, antibodies, bacteriophages, extracellular vesicles, and macrocycles. Finally, we discuss innovations in artificial intelligence (AI)-assisted antimicrobial development and stimulus-responsive materials, before introducing a conceptual design framework for antibiotic-free antimicrobial materials. This review provides a comprehensive assessment of emerging antibiotic-free strategies to guide the development of next-generation antimicrobial solutions that reduce reliance on antibiotics and mitigate AMR in clinical and healthcare settings.<\/jats:p>","DOI":"10.3390\/pharmaceutics18091136","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T08:07:41Z","timestamp":1789027661000},"page":"1136","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Antibiotic-Free Strategies for Managing Antimicrobial-Resistant Infections"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1042-5910","authenticated-orcid":false,"given":"Payal","family":"Ganguly","sequence":"first","affiliation":[{"name":"Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK"},{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS9 7TF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9365-2283","authenticated-orcid":false,"given":"Elena A.","family":"Jones","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS9 7TF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5205-7696","authenticated-orcid":false,"given":"Peter V.","family":"Giannoudis","sequence":"additional","affiliation":[{"name":"Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK"},{"name":"Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9426-4220","authenticated-orcid":false,"given":"Giuseppe","family":"Tronci","sequence":"additional","affiliation":[{"name":"School of Dentistry, St. James\u2019s University Hospital, University of Leeds, Leeds LS9 7TF, UK"},{"name":"Clothworkers\u2019 Centre for Textile Materials Innovation for Healthcare (CCTMIH), School of Design, University of Leeds, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"ref_1","unstructured":"GBD 2021 Antimicrobial Resistance Collaborators (2024). 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