Targeting microbial biofilms: current and prospective therapeutic strategies

In this Review, Stoodley and colleagues discuss current therapeutic strategies and those under development for the treatment of pathogenic biofilms. They explore novel technologies that promise to enhance the efficacy of current therapeutics or provide novel effects and argue that treating biofilm infections requires combination therapies. Biofilm formation is a key virulence factor for a wide range of microorganisms that cause chronic infections. The multifactorial nature of biofilm development and drug tolerance imposes great challenges for the use of conventional antimicrobials and indicates the need for multi-targeted or combinatorial therapies. In this Review, we focus on current therapeutic strategies and those under development that target vital structural and functional traits of microbial biofilms and drug tolerance mechanisms, including the extracellular matrix and dormant cells. We emphasize strategies that are supported by in vivo or ex vivo studies, highlight emerging biofilm-targeting technologies and provide a rationale for multi-targeted therapies aimed at disrupting the complex biofilm microenvironment.