The treatment of *Acinetobacter baumannii* infections remains a significant challenge for healthcare professionals worldwide. The bacterium is known for its extensive resistance to various antibiotics, including beta-lactams, quinolones, aminoglycosides, and tetracyclines, due to mechanisms such as beta-lactamase production, outer membrane protein changes, and multidrug efflux pumps. The severity of *A. baumannii* infections, ranging from urinary tract infections to severe conditions like ventilator-associated pneumonia (VAP) and bloodstream infections (BSI), underscores the need for effective treatment strategies. The Infectious Diseases Society of America (IDSA) and the European Society for Clinical Microbiology and Infection (ESCMID) guidelines recommend the use of sulbactam, polymyxins (polymyxin E and B), tigecycline, and aminoglycosides as primary treatments for multidrug-resistant (MDR) and extensively drug-resistant (XDR) *A. baumannii* infections. Recent studies have highlighted the effectiveness of high-dose sulbactam, which has shown lower mortality rates compared to comparator regimens. Cefiderocol, a siderophore cephalosporin, has also gained attention, with some studies suggesting it may be non-inferior to high-dose meropenem in treating VAP. However, the European guidelines advise against its use, while the IDSA recommends it conditionally. Polymyxins, particularly polymyxin E (colistin), remain crucial in severe infections, often used in combination with other agents. Tigecycline, while retaining in vitro activity, may require higher doses to achieve adequate blood levels. Aminoglycosides are recommended as part of combination regimens rather than monotherapy. The use of fosfomycin and rifampicin remains less established, with limited clinical evidence. Overall, the treatment landscape for *A. baumannii* infections is evolving, with a focus on combination therapies and the exploration of newer antibiotics like cefiderocol.The treatment of *Acinetobacter baumannii* infections remains a significant challenge for healthcare professionals worldwide. The bacterium is known for its extensive resistance to various antibiotics, including beta-lactams, quinolones, aminoglycosides, and tetracyclines, due to mechanisms such as beta-lactamase production, outer membrane protein changes, and multidrug efflux pumps. The severity of *A. baumannii* infections, ranging from urinary tract infections to severe conditions like ventilator-associated pneumonia (VAP) and bloodstream infections (BSI), underscores the need for effective treatment strategies. The Infectious Diseases Society of America (IDSA) and the European Society for Clinical Microbiology and Infection (ESCMID) guidelines recommend the use of sulbactam, polymyxins (polymyxin E and B), tigecycline, and aminoglycosides as primary treatments for multidrug-resistant (MDR) and extensively drug-resistant (XDR) *A. baumannii* infections. Recent studies have highlighted the effectiveness of high-dose sulbactam, which has shown lower mortality rates compared to comparator regimens. Cefiderocol, a siderophore cephalosporin, has also gained attention, with some studies suggesting it may be non-inferior to high-dose meropenem in treating VAP. However, the European guidelines advise against its use, while the IDSA recommends it conditionally. Polymyxins, particularly polymyxin E (colistin), remain crucial in severe infections, often used in combination with other agents. Tigecycline, while retaining in vitro activity, may require higher doses to achieve adequate blood levels. Aminoglycosides are recommended as part of combination regimens rather than monotherapy. The use of fosfomycin and rifampicin remains less established, with limited clinical evidence. Overall, the treatment landscape for *A. baumannii* infections is evolving, with a focus on combination therapies and the exploration of newer antibiotics like cefiderocol.