Abstract
Antimicrobial resistance is a critical global health issue exacerbated by biofilm-associated infections that often resist conventional therapies. Photodithazine-mediated antimicrobial photodynamic therapy (PDZ-aPDT) has emerged as a promising alternative, demonstrating a broad-spectrum antimicrobial efficacy against multidrug-resistant bacteria and fungi, including those in biofilms. This systematic review evaluates the efficacy, safety, and clinical applications of PDZ-aPDT by synthesizing evidence from preclinical and clinical studies. Databases including PubMed, Embase, Scopus, and Cochrane were systematically searched, resulting in the inclusion of 13 studies for qualitative analysis. PDZ-aPDT consistently reduced the microbial burden in various models, including oral candidiasis, denture stomatitis, acne, and infections related to medical devices. Synergistic combinations with conventional antimicrobials and adjunctive therapies (e.g., DNase I) further enhanced its effectiveness. However, the evidence base remains limited by methodological variability, small sample sizes, and short follow-up periods. Future research should focus on rigorous clinical trials with standardized protocols and extended follow-up to establish definitive efficacy and safety profiles, facilitating a broader clinical implementation in combating antimicrobial resistance.