Antibiotic resistance is a major driver of morbidity
and mortality
worldwide, necessitating alternatives. Due to their mechanism of action,
bacteriophages, endolysins, and antimicrobial peptides (coined herein
as nonantibiotic antibacterials, NAA) have risen to tackle this problem
and led to paradigms in treating antibiotic-resistant bacterial infections.
However, their clinical applications remain challenging and have been
seriously hampered by cytotoxicity, instability, weak bioactivity,
low on-target bioavailability, high pro-inflammatory responses, shorter
half-life, and circulatory properties. Hence, to transit preclinical
phases and beyond, it has become imperative to radically engineer
these alternatives into innovative and revolutionary therapeutics
to overcome recalcitrant infections. This perspective highlights the
promise of these agents, their limitations, promising designs, nanotechnology,
and delivery approaches that can be harnessed to transform these
agents. Finally, I provide an outlook on the remaining challenges
that need to be tackled for their widespread clinical administration.