Abstract

The spread of multidrug-resistant (MDR) bacteria has renewed interest in combining the targeted killing of bacteriophages with immunomodulatory antimicrobial peptides (AMPs). AMPs offer broad antimicrobial, antibiofilm, and immunomodulatory effects, although their efficacy is limited by stability, delivery, and toxicity. Phage-based systems may help address some of these limitations by localizing antimicrobial activity and improving bacterial targeting. In this perspective, we treat engineered phages as programmable “Trojan horses” that deliver AMPs into their bacterial targets, framing this concept alongside the rapid growth of AI-guided AMP design as well as phage–host matching. The evidence thus far is largely preclinical. AMP-armed phages have shown activity in vitro and in animal models, while engineered phages have only recently entered early-phase clinical trials. Reasons why phage-delivered AMPs remain largely in the preclinical and early translational stages are delineated. We argue that the primary hurdle lies in the gap between the separate advancement of AMP design on one end and phage–host matching on the other. The alignment of these interests, along with manufacturing and regulatory efforts, will likely be what allows this therapy to reach the bedside.

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