ABSTRACT:
Antimicrobial resistance (AMR) represents one of the most critical global public health challenges of the 21st century, compromising the efficacy of conventional therapies and significantly increasing morbidity and mortality associated with bacterial infections. In this context, the search for alternative therapeutic agents has intensified, with particular emphasis on natural products. Allium sativum (garlic) has emerged as a promising phytotherapeutic agent due to its long history of medicinal use and its broad spectrum of biological activities. This study aimed to systematically review the scientific literature, following PRISMA guidelines, to evaluate the antimicrobial potential of garlic against multidrug-resistant (MDR) bacteria. A comprehensive search was conducted across PubMed, Scopus, Web of Science, and ScienceDirect, covering publications from 2000 to 2025. Of 640 records initially identified, 50 studies met inclusion criteria for qualitative analysis. Results demonstrate that garlic exhibits significant antimicrobial activity against a wide range of Gram-positive and Gram-negative bacteria, including MDR strains. Biological effects are primarily attributed to organosulfur compounds such as allicin, ajoene, and diallyl sulfides, which act through multiple mechanisms including enzyme inhibition via thiol interaction, disruption of bacterial membranes, quorum sensing inhibition, and antibiofilm activity. Additionally, garlic has shown potential as an adjuvant therapy, enhancing the efficacy of conventional antibiotics. Despite these promising findings, important limitations remain, including instability of bioactive compounds, variability in chemical composition, lack of standardization, and limited clinical evidence. Further research focusing on formulation strategies, clinical trials, and pharmacokinetic studies is essential to enable the clinical translation of garlic-based therapies. In conclusion, Allium sativum represents a promising natural alternative in the fight against antimicrobial resistance, offering a multi-target approach that may contribute to the development of novel therapeutic strategies..