Link between physical activity, nutrition, and antimicrobial pharmacokinetics and therapeutic efficacy: Implications for resistance management

Antimicrobial resistance (AMR) is a critical global health challenge, as it reduces the effectiveness of current therapies and demands novel integrative approaches. This narrative, integrative review analyzes how physical activity and nutrition interact with the pharmacological design of antimicrobial agents, influencing their absorption, metabolism, distribution, efficacy, and resistance development, drawing on studies published between 2015 and 2025 across microbiology, pharmacology, nutrition, and exercise physiology. Available evidence indicates that physical activity enhances immune competence, modifies pharmacokinetics, and promotes microbiome diversity, whereas nutrition influences bioavailability, micronutrient support, and nutrient–drug interactions. Conditions such as obesity, malnutrition, and metabolic disorders can critically alter drug disposition and therapeutic outcomes. Nutraceuticals and functional foods may act synergistically with antimicrobials, although antagonistic effects can impair their absorption or potency, and lifestyle-driven modulation of the microbiota and host metabolism appears to play an important role in resistance pathways. Emerging strategies, including prodrugs, nanocarriers, and personalized dosing algorithms, have the potential to optimize therapy according to lifestyle and metabolic profiles. Overall, incorporating lifestyle determinants into antimicrobial research and stewardship may improve therapeutic efficacy, reduce resistance, support precision medicine, and position diet and physical activity as key modulators of infection management.