Review discusses sequential eradication strategies using EGCG, baicalin, and other compounds for potential therapeutic applications

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Frontiers in Medicine Published May 26, 2026 Medically reviewed May 26, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider manufacturing and regulatory complexities before translating multi-component eradication strategies into clinical practice.

This publication is a review that discusses a sequential eradication strategy comprising barrier disruption, metabolic resuscitation, and terminal eradication via microenvironment-responsive delivery systems. The specific compounds mentioned include epigallocatechin gallate, baicalin, Astragalus polysaccharides, berberine, and shikonin. The scope of the review focuses on the conceptual framework of this multi-component approach rather than primary trial data. No specific population, sample size, or setting was reported for the synthesis.

The authors highlight that the main results are not quantified with specific percentages or p-values in the provided text. Instead, the discussion centers on the feasibility of implementing these therapies. The review acknowledges that manufacturing and regulatory complexities are significant barriers to clinical adoption. Consequently, the practice relevance is limited to the need for further development and regulatory clearance before these strategies can be widely used.

Safety profiles, adverse events, and tolerability were not reported in the source material. The review does not provide data on discontinuations or serious adverse events. The certainty of the findings is constrained by the lack of reported primary outcomes and the absence of a defined study population. Clinicians should interpret these findings as conceptual rather than evidence-based recommendations for immediate practice.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

Bacterial persister cells within extracellular polymeric substance (EPS) matrices drive antimicrobial tolerance and chronic infection relapse. Conventional bactericidal agents remain fundamentally inadequate against these dormant subpopulations due to their reliance on active cellular metabolism. This review proposes a mechanistically driven, multi-phase sequential strategy—comprising barrier disruption, metabolic resuscitation, and terminal eradication—executed via highly purified, plant-derived natural products and advanced delivery systems. We synthesize recent pharmacological evidence regarding the anti-biofilm mechanisms of these active monomers and their integration with microenvironment-responsive strategies. A three-phase framework is delineated. Phase I utilizes epigallocatechin gallate (EGCG) and baicalin to physically degrade the EPS architecture and antagonize quorum sensing networks. Phase II employs Astragalus polysaccharides (APS) and exogenous metabolites to restore microbicidal host immunity and reactivate bacterial central carbon metabolism. Phase III leverages this reactivated state, utilizing berberine and shikonin to induce lethal reactive oxygen species (ROS) accumulation and terminal respiratory arrest. To resolve the pharmacokinetic limitations of these phytochemicals, we conceptualize integrating stimuli-responsive delivery systems for chronologically programmed drug release triggered by biofilm microenvironmental gradients. Ultimately, this sequential “disrupt-awaken-kill” strategy offers a potent framework to eradicate recalcitrant persisters, though translating these multi-component therapies into clinical practice requires overcoming existing manufacturing and regulatory complexities.