Background/Aim: One of the most studied bacterial resistance mechanisms is the resistance related to multidrug efflux pumps. In our study the pump activity of the Escherichia coli K-12 AG100 strain expressing the AcrAB-TolC pump system was investigated at pH 7 and pH 5 in the presence of the efflux pump inhibitor (EPI) promethazine (PMZ). Materials and Methods: The EPI activity was assessed by real-time fluorimetry. The influence of PMZ treatment on the relative expression of the pump genes acrA, acrB and their regulators marA, marB, marR, the stress genes soxS, rob, as well as the bacterial growth control genes ftsI, and sdiA were determined by RT-qPCR. Results: The EPI activity of PMZ was more effective at neutral pH. The PMZ treatment induced a significant stress response in the bacterium at acidic pH by the up-regulation of genes. Conclusion: The genetic system that regulates the activity of the main efflux pump is pH-dependent. Bacterial infections that are resistant to two or more classes of antibiotics are deemed multidrug resistant (MDR). The frequency of MDR clinical isolates is global and renders commonly available antibiotics useless. Among the many ways by which the MDR phenotype arises, the over-expression of MDR transporters promotes the expelling of antibiotics and other toxins from the bacterium prior to their reaching their targets (1). The main efflux pump of E. coli K-12 AG100 is the AcrAB-TolC system which is either transiently over-expressed in the MDR isolate or permanently over-expressed as a 65 This article is freely accessible online.