Global growth in antimicrobial resistance (AMR) has accelerated the need for novel therapy beyond the scope of conventional antibiotics. In the last decade, polydopamine (PDA), a mussel-inspired polymer with redox capability, remarkable adhesion, and biocompatibility, has emerged as a universal antimicrobial coating with widespread uses. At the same time, extracellular vesicles (EVs) and particularly exosomes have gained prominence for their intrinsic cargo delivery and immune-modulating properties. Here, we summarize the synergistic value of PDA and exosome integration into multifunctional antimicrobial nanoplatforms. We discuss the inherent antimicrobial activity of PDA and exosomes; the advantages of PDA coating, including increased exosome stability, ROS generation, and surface functionalization; and current methodologies towards designing PDA-exosome hybrids. This review also mentions other antimicrobial polymers and nanocomposites that may be employed for exosome modification, such as quaternized chitosan, zwitterionic polymers, and polymer-metal composites. Most significant challenges, such as the maintenance of exosome integrity, coating uniformity, biocompatibility, scalability, and immunogenicity, are addressed. Finally, future research directions are highlighted, with emphasis on intelligent, stimulus-responsive coatings, AMP incorporation, and clinical translation. Collectively, this review underscores the promise of PDA-coated exosomes as potential antimicrobial therapeutics against AMR with potential applications in wound healing, implant protection, and targeted infection control.