The rapid emergence and global dissemination of antimicrobial-resistant (AMR) pathogens have become one of the most serious public health challenges of the twenty-first century. The excessive use and misuse of antibiotics in human medicine, veterinary practice, and agriculture have accelerated the evolution of multidrug-resistant bacteria, fungi, and other pathogenic microorganisms, reducing the effectiveness of conventional antimicrobial therapies. Consequently, the development of novel antimicrobial agents with unique mechanisms of action has become an urgent research priority. Metal coordination complexes have emerged as promising therapeutic candidates because of their structural diversity, tunable physicochemical properties, and ability to interact with multiple microbial targets simultaneously. Coordination compounds containing silver, copper, zinc, cobalt, ruthenium, iron, nickel, and gold exhibit broad-spectrum antimicrobial activity against Gram-positive bacteria, Gram-negative bacteria, fungi, and drug-resistant pathogens. Their antimicrobial mechanisms include disruption of microbial cell membranes, DNA binding, enzyme inhibition, reactive oxygen species generation, interference with protein synthesis, and inhibition of biofilm formation. Recent advances in medicinal inorganic chemistry, ligand engineering, nanotechnology, and targeted drug delivery have further enhanced the therapeutic potential of metal coordination complexes while minimizing toxicity toward host tissues. This review discusses the chemistry of metal coordination complexes, antimicrobial mechanisms, activity against multidrug-resistant pathogens, current biomedical applications, challenges, and future perspectives in combating antimicrobial resistance.
