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As discussed in the post "How Chronic Infections Affect Our Body," chronic infections often cause localized and systemic health issues and it's often associated with chronic health conditions like autoimmune conditions and neurodegenerative conditions.

One common characteristic of chronic infections is that it's chronic and recurrent, often fail to respond to standard antimicrobial treatments like antibiotics and antifungals effectively or develop resistance to these drugs.

Biofilms are often the major underlying root cause that allows the pathogens to thrive and become resistant to the attack of our immune system and antimicrobial treatments, and without addressing biofilms, chronic infections tend to linger and not resolve.

What are biofilms?

Biofilms are formed when microorganisms attach to surfaces and build a complex, slimy structure to protect themselves from the external environment.

Life cycles of biofilms

The life cycle of biofilms usually involves a few stages:

  1. Adhesion – bacteria adhere to moist surfaces. This attachment can be reversible or irreversible.

  2. EPS production – from this step onward, the attachment is irreversible, and the bacteria start to produce extracellular polymeric substances (EPS), the slimy structure to protect themselves. They start to colonize the surfaces and they can communicate with each other within the biofilms.

  3. Maturation – formation of a complex microenvironment where the acidity is low and there is a lack of oxygen. The structure gets stronger and some bacteria become dormant and persistent.

  4. Dispersion – bacteria secrete substances like enzymes and surfactants to destroy EPS (the biofilm “wall”), dispersing bacteria to other locations and forming new colonies and biofilms at new surfaces.

Inside biofilms, there are usually colonies of different microorganisms, including bacteria, viruses, and parasites. They can attach themselves to different types of moist surfaces, like medical devices, bathtubs, sinks, piping, etc. Inside our body, biofilms can be formed on mucosal surfaces (e.g. respiratory tract, urinary tract, vaginal tract), teeth, skin, and the gastrointestinal tract.

Examples of biofilms would be the slimy structures forming on our bathtubs, sinks, and our teeth.

Health impacts of biofilms

Biofilms protect these microorganisms from the attack of our immune system and pharmaceuticals like antibiotics and antifungals, allowing these microorganisms to continue to grow. If these microorganisms are pathogenic (disease-causing), they can continue to produce toxins and inflammations and create systemic health issues. Biofilms are another major reason infections become chronic, recurrent, and antimicrobial/drug-resistant.

Chronic and/or recurrent infections like bronchitis, periodontitis, sinusitis, vaginitis, UTIs (urinary tract infections), SIBO (small intestine bacterial overgrowth), and intestinal candida/yeast overgrowth are examples of chronic infections commonly related to biofilms.

Common scenarios when there’s an issue of pathogenic biofilms

  • Having recurrent infections. E.g. sinusitis that comes back once every few months, vaginal yeast infection that comes back every month. (The infection never gets cleared up completely)

  • Antibiotics and antifungals no longer work as well at clearing up the infection.

  • Infections return quickly after stopping antibiotics/antifungals (pharmaceutical or natural antimicrobials).

  • Having infected with antibiotic or antifungal-resistant (drug-resistant) strains.

Since biofilms are related to chronic infections, the health impacts of chronic infections are tied closely to pathogenic biofilms too.

In order to resolve or control infections effectively, especially chronic infections, we always need to address biofilms while using antimicrobial agents (pharmaceutical or natural).

How to resolve biofilms?

There are many anti-biofilm agents capable of inhibiting the formation of biofilms or breaking up the “shell” of biofilms, examples include:

  • Silver nanoparticles

  • Herbs/natural compounds

    • Garlic

    • Oregano oil

    • Curcumin

    • European horse chestnut

    • American cranberry

    • Tea tree oil

    • Cinnamon

    • Quercetin

  • Enzymes like cellulase, serratiopeptidase, nattokinase

  • N-acetylcysteine (NAC)

  • Bismuth thiols

Resolving biofilms and establishing a healthy microbiota within our body usually requires utilizing anti-biofilm agents with antimicrobials (pharmaceutical or natural) concurrently, so we can break up the “shields” of these pathogenic microorganisms, release them, and then kill them. Meanwhile replenishing our gut flora with probiotics to rebuild a healthy flora and to strengthen our immune function.


  1. López, Daniel et al. “Biofilms.” Cold Spring Harbor perspectives in biology vol. 2,7 (2010): a000398. doi:10.1101/cshperspect.a000398

  2. Bu, Fanqiang, et al. "Targeted Anti-Biofilm Therapy: Dissecting Targets in the Biofilm Life Cycle." Pharmaceuticals 15.10 (2022): 1253.

  3. Mishra, Rojita, et al. "Natural anti-biofilm agents: strategies to control biofilm-forming pathogens." Frontiers in Microbiology11 (2020): 566325.

  4. Domenico, P. "Bismuth Thiols as anti-biofilm agents." J Microbiol Exp 2.3 (2015): 00049.

  5. Jadhav, Swati B., et al. "Serratiopeptidase: Insights into the therapeutic applications." Biotechnology Reports 28 (2020): e00544.

  6. Blasi, Francesco, et al. "The effect of N-acetylcysteine on biofilms: Implications for the treatment of respiratory tract infections." Respiratory medicine 117 (2016): 190-197.


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