The Beyond Antibiotics programme, Institute of Biomedical Engineering, University of Oxford - Translation of research

This project is focused on translating our research findings into practice. Continuous engagement activities have been integrated into our Beyond Antibiotics research programme. These activities help ensure that our research developments enter the market and can be successfully commercialised. Both the system design and wider context of antimicrobial resistance are considered in our translational efforts. 

Ongoing Clinical Trial

The Beyond Antibiotics Team are currently undertaking a feasibility, single-centre, randomised, -controlled, double-blind, study to assess the safety, practicality, and patient acceptability of using ultrasound-activated microbubbles to aide topical antibiotic delivery in infected burn wounds (MHRA; Ref: CTA 21381/0004/001-0001) and Health Research Authority (HRA) and Research Ethics Committee (REC) approval (Ref: 25/LO/0907)) for first-in-human feasibility evaluation in infected partial-thickness burns within an NHS burns service.). 

Background to the Clinical Trial 

Antimicrobial resistance (AMR) represents a major and escalating global healthcare challenge. A key contributor to antimicrobial treatment failure is the ability of bacteria to evade therapeutic exposure through intracellular persistence and biofilm formation. Intracellular bacterial reservoirs reduce exposure to systemically delivered antibiotics, while biofilms create structural and biochemical barriers that significantly limit antimicrobial penetration. These mechanisms increase infection recurrence, drive repeated antibiotic escalation and contribute directly to antimicrobial resistance development. Prolonged or high-dose systemic antibiotic exposure may provide temporary clinical benefit but can disrupt host microbiota and immune function, further perpetuating infection.

Burn injury patients are particularly vulnerable to these mechanisms. Burn wounds frequently become colonised by multi-drug-resistant organisms and develop complex biofilms that impair antimicrobial efficacy and delay healing. This represents a major clinical burden. Ultrasound-activated microbubble technologies provide a credible and evidence-based approach to addressing this challenge. Gas-filled microbubbles have been safely used as ultrasound contrast agents in clinical imaging for over two decades. When exposed to ultrasound, microbubbles oscillate and generate local mechanical forces (cavitation) that facilitate drug delivery, disrupt biofilm architecture and transiently permeate cellular membranes through sonoporation. These combined effects improve both extracellular antibiotic distribution and intracellular antimicrobial uptake, directly addressing key biological barriers to antimicrobial efficacy.

The scientific and engineering basis of this approach has been developed over more than a decade within the University of Oxford microbubble research group. Work led by an internationally recognised group in therapeutic microbubble physics and drug delivery has characterised microbubble formulation, acoustic activation physics, ultrasound–microbubble dynamics and drug delivery performance across multiple models. In preclinical infection models using clinically derived bacterial isolates, ultrasound activation of clinically relevant microbubbles has been shown to reduce antibiotic concentrations required for bactericidal and biofilm eradication effects by up to 7–44 fold. These systems have also demonstrated greater than tenfold increases in intracellular antibiotic accumulation within biofilm generating bacteria.