Antimicrobial sonodynamic therapy: recent advances and challenges in new therapeutic approaches to antimicrobials

Pathogenic microorganisms pose significant threat to global health. In particular, conventional antibiotic treatments run the risk of exacerbating bacterial resistance. Antimicrobial sonodynamic therapy (aSDT), which combines sonosensitizers and low-intensity ultrasound (US), has opened up new avenues for the treating drug-resistant bacteria. The appeal of this therapy lies in its ability to focus US energy toward the deep-seated site of bacterial infection sites, it locally activates sonosensitizers and generates cytotoxic reactive oxygen species (ROS), which ultimately induces bacterial death. In the last decade, aSDT has been rapidly developed due to its good penetrative, biocompatibility and targeting properties. This paper highlights the recent aSDT advances in antimicrobial applications. We review aSDT mechanisms and sonosensitizers types, and propose relevant strategies to improve aSDT effects in terms of improving hypoxia and combining applications with other therapies. Furthermore, we summarize the potential obstacles and opportunities for the advancement of aSDT, and provide a deeper understanding of sonodynamic therapy (SDT) for antimicrobial applications, thereby promoting further innovation and clinical application.