Advances of Chinese herbal medicine and its active ingredients in the treatment of antibiotic-resistant Klebsiella pneumoniae infections: Therapeutic efficacy, mechanisms, and combination strategies

Klebsiella pneumoniae is a widespread Gram-negative bacterium in Asia, and the emergence of antibiotic-resistant strains has significantly complicated treatment strategies. Traditional Chinese medicine, which has made remarkable contributions to public health in Asia for thousands of years, may offer promising antibacterial strategies. Chinese herbal medicine (CHM), the primary therapeutic modality of traditional Chinese medicine, exhibits antimicrobial activity, modulates the immune system, and has the potential to reverse antibiotic resistance through various mechanisms. However, no review has comprehensively summarized the efficacy and underlying mechanisms of CHM in treating antibiotic-resistant K. pneumoniae infections. In this study, we conducted a comprehensive review of relevant literatures published up to 2025, using the keywords “ Klebsiella pneumoniae ,” “traditional Chinese medicine,” and “Chinese herbal medicine” across databases including PubMed, Web of Science, ScienceDirect, and China National Knowledge Infrastructure. This review first introduces the taxonomy, virulence factors, and antibiotic resistance profile of K. pneumoniae . We then summarize CHM formulas, extracts, and active ingredients with reported antibacterial effects against K. pneumoniae , including their minimum inhibitory concentrations and mechanisms. Additionally, we highlight CHM interventions that enhance host immune responses and alleviate symptoms associated with K. pneumoniae infections. Furthermore, combining CHM with antibiotics represents a novel strategy to enhance antibiotic efficacy and combat resistance. We therefore summarize the synergistic effects and mechanisms of CHM–antibiotic combinations. Overall, this review underscores the multifaceted therapeutic potential of CHM and its active ingredients, including direct antibacterial action, immune modulation, and synergy with conventional antibiotics, providing an integrative approach to address the global challenge of antimicrobial resistance.