A review on antibiotic and non-antibiotic decolonization strategies of multidrug-resistant bacteria in the gastrointestinal tract

The escalating global threat of antimicrobial resistance represents a critical challenge for contemporary medicine. Intestinal colonization by multidrug-resistant organisms (MDROs) is increasingly identified as a primary driver of hospital-acquired infections across various patient cohorts. While localized eradication via non-absorbable antibiotics was once viewed as a viable strategy, clinical evidence has failed to demonstrate its efficacy. Consequently, attention has shifted toward microbiome-modulating interventions, such as fecal microbiota transfer (FMT), probiotics, and live biotherapeutic products (LBPs), which have shown potential in preliminary studies. However, current evidence remains fragmented and lacks the support of large-scale randomized controlled trials (RCTs). This review critically assesses both traditional and novel decolonization methods and features a comprehensive summary of clinical studies to highlight existing research gaps. A notable limitation of this analysis is the absence of a formal methodological quality assessment for the included studies. Ultimately, definitive conclusions remain elusive, necessitating future large-scale, pathogen-specific RCTs to validate these emerging approaches.