AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO026110120
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ORIGINAL RESEARCH ARTICLE

Clinical efficacy, safety, and pharmacologic determinants of antimicrobial peptides: A systematic review and meta‑analysis

Nusrat Sultana Mimi1 ,  Abdullah Al Noman2 ,  Md. Jakaria Parvez3 ,  Bratakatha Nath4 ,  Tahmina Ansary Roshnee5 ,  Md Al Amin Talukder6 ,  Istiyak Ahmmed Shaku7 ,  Shubham Singh8,9 ,  Dharmendra Singh Rajput10 ,  Vetriselvan Subramaniyan11,12,13,14*
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1 Department of Health and Wellness Services, Western Illinois University, Macomb, Illinois, USA
2 School of Pharmacy, BRAC University, Dhaka, Bangladesh
3 Department of Pharmacy, University of Development Alternative, Dhaka, Bangladesh
4 Department of Pharmaceutics, Anand Pharmacy College, Anand, Gujarat, India
5 Department of Pharmacology, University of Asia Pacific, Dhaka, Bangladesh
6 Department of Chemistry, Eastern Michigan University, Ypsilanti, Michigan, USA
7 Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka, Bangladesh
8 School of Pharmacy, Rai University, Ahmedabad, Gujarat, India
9 Department of Pharmaceutics, ISF College of Pharmacy (An Autonomous College), Moga, Punjab, India
10 Department of Pharmaceutics, Mittal Institute of Pharmacy, Bhopal, Madhya Pradesh, India
11 Department of Pharmacology, Faculty of Medical and Life Sciences, Sunway University, Bandar Sunway, Selangor Darul Ehsan, Malaysia
12 Department of Pharmacy, Faculty of Pharmacy, Karpagam Academy of Higher Education (Deemed to be University), Coimbatore, Tamil Nadu, India
13 Faculty of Health Sciences, Villa College, Maldives
14 Global Research Cell, Dr. D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, India
EJMO, 026110120 https://doi.org/10.36922/EJMO026110120
Received: 9 March 2026 | Revised: 28 April 2026 | Accepted: 6 May 2026 | Published online: 19 June 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: Antimicrobial resistance poses an escalating global health threat, driving the need for alternative therapeutic strategies beyond conventional antibiotics. Despite extensive preclinical research, the clinical performance of these agents remains incompletely characterized.

Objective: This systematic review and meta-analysis synthesize and evaluate clinical efficacy, safety, and pharmacologic determinants of antimicrobial peptide therapeutics in human studies, and determine their comparative performance against standard-of-care treatments.

Methods: A comprehensive search of PubMed, Embase, Web of Science, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform identified eligible clinical studies published between January 2000 and January 2026. Randomized controlled trials and comparative clinical studies reporting clinical or microbiologic outcomes were included in the quantitative meta-analysis. Early-phase, single-arm, or non-comparative studies were synthesized qualitatively. A random-effects model was used to estimate pooled risk ratios (RRs) for clinical cure, and heterogeneity was assessed using the I2 statistic.

Results: Six comparative clinical studies involving 1,418 participants were included in the meta-analysis. Pooled analysis demonstrated no statistically significant difference in clinical cure between peptide-based therapeutics and standard-of-care treatments (RR 1.06, 95% confidence interval: 0.97–1.17), with moderate heterogeneity (I2 = 64.7%). Early-phase and single-arm studies reported high clinical cure rates, particularly in biofilm-associated or localized infections. Subgroup analyses indicated that topical or locally-administered peptides produced more consistent therapeutic outcomes, whereas systemic administration showed greater variability and was more frequently limited by toxicity.

Conclusion: Antimicrobial peptides demonstrate promising activity in specific clinical contexts, particularly biofilm-related and drug-resistant infections. While current evidence does not show superiority over standard-of-care therapies, early-phase data highlight their potential in niche indications. Future development should prioritize optimizing therapeutic index, improving targeted delivery strategies, and designing infection-specific clinical trials to fully realize the clinical potential of this emerging therapeutic class. 

Graphical abstract
Keywords
Antimicrobial peptides
Antimicrobial resistance
Biofilm-associated infections
Drug-resistant bacteria
Clinical trials
Funding
None.
Conflict of interest
The authors declare no conflicts of interest.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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