The problem of antibiotic resistance is on the rise,
with multidrug-resistant
strains emerging even to the last resort antibiotics. The drug discovery
process is often stalled by stringent cut-offs required for effective
drug design. In such a scenario, it is prudent to delve into the varying
mechanisms of resistance to existing antibiotics and target them to
improve antibiotic efficacy. Nonantibiotic compounds called antibiotic
adjuvants which target bacterial resistance can be used in combination
with obsolete drugs for an improved therapeutic regime. The field
of “antibiotic adjuvants” has gained significant traction
in recent years where mechanisms other than β-lactamase inhibition
have been explored. This review discusses the multitude of acquired
and inherent resistance mechanisms employed by bacteria to resist
antibiotic action. The major focus of this review is how to target
these resistance mechanisms by the use of antibiotic adjuvants. Different
types of direct acting and indirect resistance breakers are discussed
including enzyme inhibitors, efflux pump inhibitors, inhibitors of
teichoic acid synthesis, and other cellular processes. The multifaceted
class of membrane-targeting compounds with poly pharmacological effects
and the potential of host immune-modulating compounds have also been
reviewed. We conclude with providing insights about the existing challenges
preventing clinical translation of different classes of adjuvants,
especially membrane-perturbing compounds, and a framework about the
possible directions which can be pursued to fill this gap. Antibiotic–adjuvant
combinatorial therapy indeed has immense potential to be used as an
upcoming orthogonal strategy to conventional antibiotic discovery.