The combination of the SH metabolite of erdosteine (a mucoactive drug) and ciprofloxacin increases the inhibition of bacterial adhesiveness achieved by ciprofloxacin alone.

Exposure to ciprofloxacin and other fluoroquinolone antibiotics at less than minimum inhibitory concentrations (MICs) reduces the production of some of the factors that contribute to bacterial virulence, particularly bacterial adhesiveness. Once metabolized, erdosteine (a mucoactive drug) produces an active metabolite (Met I) with a reducing sulfhydryl group that is capable of opening the disulfide bonds present in tracheobronchial mucins and pilins, a protein of bacterial fimbriae (adhesins). This induces stereoconformational changes that interfere with the binding of bacterial adhesins to the receptors on mucosal cells. The combination of 5 and 10 micrograms/ml of Met I and 1/4, 1/8, 1/16 MICs of ciprofloxacin potentiated the inhibition of Staphylococcus aureus and Escherichia coli adhesiveness to human mucosal cells in comparison with ciprofloxacin alone. This finding opens up an interesting new possibility for interfering with bacterial adhesiveness and the resulting virulence by combining antibiotics with agents devoid of antibacterial activity.