IJAA Editor's Choice

The following article has been selected as 'Editor's Choice' for the February issue of IJAA:

All editor's choice articles are free to access for a limited time.

Mefloquine enhances the activity of colistin against antibiotic-resistant Enterobacterales in vitro and in vivo animal studies (Hu et al)

Editor's comment:

The fight against multidrug-resistant bacteria, including carbapenemase-producing bacteria, requires the search for new therapeutic options. In this field, drug repurposing is an interesting option because it can be rapidly transferred to the clinic. The authors of this work have studied the in vitro efficacy of a combination of colistin, a last-line antibiotic used in the treatment of multidrug-resistant Gram-negative bacterial infections, with an antimalarial drug, mefloquine, for the treatment of carbapenemase-producing enterobacterial infections. This combination showed a synergistic activity against NDM-1-, MCR-1- and ESBL- producing enterobacteria in checkerboard analysis. This activity was confirmed to be bactericidal by time kill study, the addition of mefloquine allowing to use a lower concentration of colistin, which could reduce its toxicity. An in vivo study on a mouse peritoneal infection model confirmed the efficacy of the treatment with significant reduction of CFU counts at 4 -6 hours after the administration of the combination at 20 mg/kg for both drugs. Mefloquine has been used for malaria prophylaxis for many years and is well known to clinicians. Its use as a booster of colistin activity would reduce the nephrotoxicity and neurotoxicity of this antibiotic. Further studies in humans are still needed to ensure the in vivo activity of this combination.