Recent advances in tackling microbial multidrug resistance with essential oils: combinatorial and nano-based strategies.

The emergence of multidrug resistant pathogens is a great challenge to the medical field and a major global health threat requiring novel therapeutic strategies. Among plant products, essential oils have significant antimicrobial properties that make them promising agents in the fight against drug resistant human pathogens. The aim of the present review was to highlight the most important essential oil-based antimicrobial strategies as revealed by recent studies. Synergistic interactions between essential oils or their bioactive compounds in combination with known antibiotics are presented. Also, nanoformulation approaches to boost the antimicrobial activity of essential oils are reviewed in terms of bioefficiency, stability and design of the nanostructured delivery systems. The focus was mainly put on the antimicrobial activity against multi-drug resistant pathogens, also called "ESKAPE" organisms (Enterococcus spp., Staphylococcus aureus, Klebsiella spp., Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.). Thus, essential oils in combinatorial and nano-based strategies may cope with infections caused by drug-resistant bacteria and may offer possibilities for reducing antibiotic use. Research on the in vivo efficacy and safety of such strategies is required for further clinical antimicrobial chemotherapy. In this regard, the understanding of the interactions between essential oil-based strategies and biological interface is essential.