Table 1.

Summary of alternative treatment strategies for fungal–bacterial biofilms.

Treatment	Strengths	Limitations	Examples	Biofilm Target	Ref.
Antimicrobial peptides	Broad-spectrum activity Low toxicity Low probability of resistance Rapid Efficient	Chemical instability High production cost Pharmacokinetic properties	gH625 analogues	C. tropicalis–S. aureus–S. marcescens C. albicans–K. pneumoniae	[75,76]
			cholic acid-peptide conjugates	C. albicans–S. aureus	[77]
			guanylated polymethacrylates	C. albicans–S. aureus	[78]
			ε-poly-L-lysine in chitosan hydrogel	P. aeruginosa–S. aureus–C. albicans	[79]
Quorum quenchers	Selective pressure only under QS conditions Low probability of resistance	May disturb microbiota homeostasis May cause enhanced virulence	thiazolidinedione-8	C. albicans–S. mutans	[80,81]
			QQ-5 and QQ-7	C. albicans–S. epidermidis	[82]
Plant-derived components	Wide variety of pharmaceutical and biological activities Low toxicity	High volatility Low stability Low bioavailability Small scale production	citral and nepodine	C. albicans–S. aureus	[83,84]
			citrus EOs and limonene	P. aeruginosa–A. fumigatus or S. apiospermum	[85]
			eugenol	C. albicans–S. mutans	[86]
			curcumin	C. albicans–S. aureus C. albicans–A. baumannii	[87,88]
			carvacrol	C. albicans–S. aureus	[89]
			Rhamnus prinoides stem extract	C. albicans–S. mutans	[90]
Photodynamic therapy	Broad-spectrum activity No toxicity Low probability of resistance	Limited effect against biofilms in vitro studies rarely translate into animal models	erythrosine—green light	C. albicans–S. sanguinis	[91]
			acrylic resins doped with Undaria pinnatifida—blue light	C. albicans–S. sanguinis–S. mutans–L. acidophilus	[92]
			Zn(II)chlorin e6 methyl ester—red light	C. albicans–E. faecalis	[93]
Chitosan	No toxicity BiodegradableLow cost Good accessibility Low immunogenicity	Poor solubility in water	carboxymethyl chitosan	C. albicans–C. tropicalis–S. epidermidis–S. salivarius–R. dentocariosa–L. gasseri	[94,95]
				C. tropicalis–S. epidermidis	[96]
Nanoparticles	Enhanced bioavailability of loaded drugs Targeted delivery Easier penetration inside biofilm Protection of drugs from external environment	Possible toxicity to mammalian cells Unknown processes of in vivo metabolism clearanceLong-term toxicity Difficult scale-up High-cost	polymeric NPs magnetic NPs mesoporous silica NPs silver NPs	cf. Table 2	[97,98]
Probiotics	Restores and maintains the balance of microbiota Good accessibility Easy to use	Limited survival of viable probiotic cells Lack of clinical studies and mode-of-action studies	S. boulardii–L. acidophilus–L. rhamnosus–B. breve with amylase	C. albicans or C. tropicalis–E. coli–S. marcenscens	[99]
			supernatant probiotic Lactobacillus	C. albicans–C. tropicalis–S. salivarius–R. dentocariosa–S. epidermidis	[100]
			L. salivarius	C. albicans–S. mutans	[101]