Efficacy of Anti-Microbial Agents with Ascorbic Acid in Catheter Associated Urinary Tract Infection

Afzal, Sana; Ashraf, Muhammad; Bukhsh, Allah; Akhtar, Syed Fazal; Ad, Rasheed

doi:10.4172/2329-8731.1000166

Cited by 5 publications

(5 citation statements)

References 29 publications

(24 reference statements)

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“…Combination of antibacterial drugs with ascorbic acid to enhance antibiotic activity was tested against a broad spectrum of uropathogenic bacteria [ 24 , 34 , 54 , 55 , 56 ]. Most of these studies verified the synergistic effect of ascorbic acid with fluoroquinolones.…”

Section: Discussionmentioning

confidence: 99%

“…Most of these studies verified the synergistic effect of ascorbic acid with fluoroquinolones. AA has been reported as an agent enhancing the effectiveness of ciprofloxacin (CIP) and ceftriaxone action in the treatment of CAUTIs induced by Candida sp., Citrobacter sp., E. coli , Enterobacter sp., and S. aureus [ 54 ]. Similarly, a combination of levofloxacin and ascorbic acid increased the reduction in biofilm formation by E. coli , Klebsiella sp., Citrobacter sp., Enterobacter sp., Proteus sp., and Pseudomonas sp.…”

Section: Discussionmentioning

confidence: 99%

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Combined Application of Aminoglycosides and Ascorbic Acid in the Elimination of Proteus mirabilis Rods Responsible for Causing Catheter-Associated Urinary Tract Infections (CAUTIs)—A Molecular Approach

Stolarek

Bernat

Różalski

2022

IJMS

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Proteus mirabilis is a common cause of catheter-associated urinary tract infections (CAUTIs). In this study, we verified the effectiveness of amikacin or gentamicin and ascorbic acid (AA) co-therapy in eliminating uropathogenic cells, as well as searched for the molecular basis of AA activity by applying chromatographic and fluorescent techniques. Under simulated physiological conditions, a combined activity of the antibiotic and AA supported the growth (threefold) of the P. mirabilis C12 strain, but reduced catheter colonization (≤30%) in comparison to the drug monotherapy. Slight modifications in the phospholipid and fatty acid profiles, as well as limited (≤62%) 2’,7’-dichlorofluorescein fluorescence, corresponding to the hydroxyl radical level, allowed for the exclusion of the hypothesis that the anti-biofilm effect of AA was related to membrane perturbations of the C12 strain. However, the reduced (≤20%) fluorescence intensity of propidium iodide, as a result of a decrease in membrane permeability, may be evidence of P. mirabilis cell defense against AA activity. Quantitative analyses of ascorbic acid over time with a simultaneous measurement of the pH values proved that AA can be an effective urine acidifier, provided that it is devoid of the presence of urease-positive cells. Therefore, it could be useful in a prevention of recurrent CAUTIs, rather than in their treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Combined Application of Aminoglycosides and Ascorbic Acid in the Elimination of Proteus mirabilis Rods Responsible for Causing Catheter-Associated Urinary Tract Infections (CAUTIs)—A Molecular Approach

Stolarek

Bernat

Różalski

2022

IJMS

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“…ASC interaction with antibiotics and antibiotic resistance has also been documented: ASC had synergic effect with sulfonamides, trimethoprim, chloramphenicol, ampicillin, erythromycin and colistin in checkerboard assays on P. aeruginosa [ 4 ]; a 1-mM ASC treatment eliminates penicillinase plasmids from S. aureus , and reduces the MIC of penicillin and tetracycline [ 10 , 11 ]; a triple combination of ASC, apo-transferrin and imipenem was effective against carbapenem-resistant A. baumannii [ 9 ]; biofilm formation by P. aeruginosa was inhibited by ASC at 11–34 mM concentrations [ 6 ] and at 0.2–2 mM (possibly non-neutralized ASC; and also diminished piperacillin, ceftazidime, ciprofloxacin and gentamicin MICs [ 5 ]); but 2 mM ascorbate reduced the biofilm inhibitory activity of aminoglycosides gentamicin and amikacin [ 8 ]; addition of 10 mM ASC decreased the MIC of some antibiotics (e.g., ampicillin, tetracycline) and increased the MIC of others (e.g., erythromycin, ciprofloxacin) when testing S. aureus , several Streptococcus spp., and E. coli [ 12 ]. In non-PubMed-indexed journals reports are even more disparate (e.g., [ 13 , 14 , 15 ]).…”

Section: Introductionmentioning

confidence: 99%

Ascorbate and Antibiotics, at Concentrations Attainable in Urine, Can Inhibit the Growth of Resistant Strains of Escherichia coli Cultured in Synthetic Human Urine

Amábile-Cuevas¹

2023

Antibiotics

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There are conflicting reports on the antibacterial activity of ascorbate; all at concentrations much higher than the typical in human plasma, but that can be reached in urine. The effect of 10 mM ascorbate (in itself not inhibitory) along with antibiotics, was tested both in Mueller-Hinton broth (MHb) and in synthetic human urine (SHU), against resistant isolates of Escherichia coli from lower urinary infections. The activity of nitrofurantoin and sulfamethoxazole was higher in SHU than in MHb; minimal inhibitory concentrations (MICs) in SHU with ascorbate were below typical urinary concentrations. For other antibiotics, MICs were the same in MHb vs. SHU, with no effect of ascorbate in MHb; but in SHU with ascorbate, MICs of ciprofloxacin and gentamicin also went below reported urinary concentrations, with a lesser effect with norfloxacin and trimethoprim, and none with ampicillin. The effect of ascorbate was independent of oxygen and not related to the susceptibility of each strain to oxidative stress. Ascorbate oxidizes during incubation in SHU, and bacterial growth partially prevented oxidation. These results suggest that 10 mM ascorbate can enhance the inhibitory activity of antibiotics upon resistant strains in urine. Clinical experimentation with ascorbate–antibiotic combinations against urinary infections caused by resistant bacteria is warranted.

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“…In general, vitamins may alter antimicrobial activity of particular antibiotics [8]. Carlsson et al (2005) [9] and Afzal et al (2017) [10] showed an increased antimicrobial activity of fluoroquinolones and aminoglycosides during AA addition. Habash et al (1999) [11] additionally proved that vitamin C decreases the adhesion and microorganisms colonization of the biomaterials used in diagnostic/treatment procedures involving the urinary tract.…”

Section: Introductionmentioning

confidence: 99%

Vitamin C in the Presence of Sub-Inhibitory Concentration of Aminoglycosides and Fluoroquinolones Alters Proteus mirabilis Biofilm Inhibitory Rate

et al. 2019

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Vitamin C has antimicrobial activity and is often used as an oral supplement accompanying antibiotic treatment in urinary tract infections (UTI). Proteus mirabilis is the third common species responsible for UTIs that are mostly treated with fluoroquinolones or aminoglycosides. Treatment of the UTI caused by P. mirabilis is problematic due to the ability to form biofilm on the urinary catheters. The aim of the study was to evaluate the influence of ascorbic acid in combination with antibiotics on P. mirabilis abilities to form biofilm. The susceptibility of P. mirabilis reference strain ATCC® 29906™ and four clinical strains isolated from the urine samples of patients with urinary catheter were evaluated according to EUCAST recommendations. The influence of ascorbic acid (0.4 mg × mL−1) in combination with antibiotics on biofilm formation was evaluated spectrophotometrically. Aminoglycosides at sub-inhibitory concentrations more successfully limited biofilm formation by P. mirabilis strains without ascorbic acid addition. Inhibition rate differences at the lowest concentrations of gentamicin and amikacin were statistically significant (p ≤ 0.05). Ascorbic acid addition to the culture medium limited the inhibitory effect of fluoroquinolones, facilitating biofilm formation by P. mirabilis strains. The addition of ascorbic acid during aminoglycosides therapy may disturb treatment of urinary tract infections related to the presence of P. mirabilis biofilm.

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Efficacy of Anti-Microbial Agents with Ascorbic Acid in Catheter Associated Urinary Tract Infection

Cited by 5 publications

References 29 publications

Combined Application of Aminoglycosides and Ascorbic Acid in the Elimination of Proteus mirabilis Rods Responsible for Causing Catheter-Associated Urinary Tract Infections (CAUTIs)—A Molecular Approach

Combined Application of Aminoglycosides and Ascorbic Acid in the Elimination of Proteus mirabilis Rods Responsible for Causing Catheter-Associated Urinary Tract Infections (CAUTIs)—A Molecular Approach

Ascorbate and Antibiotics, at Concentrations Attainable in Urine, Can Inhibit the Growth of Resistant Strains of Escherichia coli Cultured in Synthetic Human Urine

Vitamin C in the Presence of Sub-Inhibitory Concentration of Aminoglycosides and Fluoroquinolones Alters Proteus mirabilis Biofilm Inhibitory Rate

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