Biofilm-associated infections pose a significant clinical challenge due to their increased antibiotic tolerance and strong association with multidrug-resistant pathogens. The biofilm protects bacteria against antimicrobial agents and host immune response through a complex matrix, altered cell metabolism, activation of quorum sensing, and overexpression of efflux pumps. Despite the availability of numerous therapeutic strategies, the effectiveness of treatment of these infections remains limited, justifying the search for new pharmaceutics, e.g., compounds of natural origin. Berberine, an isoquinoline alkaloid from the plants of the Berberidaceae family, is of growing interest due to its broad spectrum of antimicrobial and antibiofilm activities. This review summarizes the current state of knowledge regarding the molecular mechanisms of action of berberine against the biofilm forming Gram-(+) and Gram-(−) bacteria. Its effect on bacterial cell adhesion, modulation of quorum sensing, inhibition of extracellular matrix synthesis, disruption of biofilm maturation, and the dispersion process are discussed. The role of berberine as an adjuvant to antibiotic therapy was also analyzed, in particular, its ability to restore bacterial sensitivity to different classes of antibiotics. The pharmacokinetic limitations of berberine and the prospects for the use of modern delivery systems are also considered. The collected data indicate that berberine is a promising factor supporting the treatment of biofilm-related infections.
Duda-Madej et al. (2026) studied this question.