Combination Antimicrobial Therapy for Bacterial Infections

Abstract

Therapy with antimicrobial combinations has been used as long as antimicrobials have been available. Combinations of antibiotics are often used to take advantage of different mechanisms of action and/or toxicity profiles. Well established indications for combination antimicrobial therapy include: (a) empirical treatment of life-threatening infections; (b) treatment of polymicrobial infections; (c) prevention of the emergence of bacterial resistance; and (d) for synergism. Disadvantages of combination therapy include: (a) increased expense; (b) increased risk of adverse effects; (c) antagonism; and (d) superinfection. Combination antimicrobial therapy should be considered for the treatment of serious Gram-negative infections caused by Enterobacter cloacae, Pseudomonas aeruginosa and Serratia marcescens, and certain Gram-positive infections caused by Enterococcus spp. and Staphylococcus spp. Selection of agents should be dependent upon local susceptibility patterns, clinical experience, site of infection, potential toxicities and cost.

Augmentation of antimicrobial activity of conventional antibiotics by cell-free extract of L. plantarum

“…The MICs of ampicillin, ciprofloxacin and ceftriaxone were evaluated to be 1 mg ml À1 , 6mg ml À1 and 12 mg ml À1 , respectively. However, according to NCCLS guidelines, S typhimurium was classified as resistant to ceftriaxone and ciprofloxacin, and susceptible to ampicillin as per the MIC breakpoints 10 (for ciprofloxacin and ceftriaxone susceptible (p1), intermediate (1)(2)(3)(4) and resistant (X4), for ampicillin susceptible (p8), intermediate and resistant (X32)).…”

Monotherapy with a Broad-Spectrum Beta-Lactam Is as Effective as Its Combination with an Aminoglycoside in Treatment of Severe Generalized Peritonitis: a Multicenter Randomized Controlled Trial

“…The treatment can subsequently be adapted according to antibiotic susceptibility test results. The addition of an aminoglycoside to the treatment regimen has many theoretical advantages: (i) a broader spectrum of activity, (ii) increased synergy, (iii) increased bactericidal effect, and (iv) prevention of emergence of resistant strains (26). However, no study that has supported the use of aminoglycosides for the treatment of SGP has been published in the literature (14,15).…”

Synergistic Effects between Mentha Piperita, Mentha Longifolia and Ocimum Basilicum on Different Bacterial Strains

“…Because of bacterial resistance against antibiotics and single treatment, using two or more alternative natural product could be interested (Rybak & McGrath, 1996). In the present study all leave extract alone and in combination with each other were revealed antimicrobial activity against all tested bacterial strain, but combination form exhibit more pronounced activity than extract alone.…”