Discovery of an adjuvant that resensitizes polymyxin B-resistant bacteria.

Infections caused by antibiotic-resistant bacteria are a major threat to health, increasing mortality rates and straining health systems worldwide. Adjuvants targeted to beta-lactamase function are able to resensitize bacteria to beta-lactam antibiotics, but there is comparatively little research into the use of adjuvants against other resistance phenotypes. In this study, we performed a high-throughput screen of 74 natural products to identify adjuvants that synergized with antibiotics to eradicate resistant Gram-negative bacteria. From this, we identified six adjuvant hits which restored growth inhibition when combined with the relevant antibiotic, and pursued a lead candidate, perforone, which possessed selective adjuvant activity in combination with polymyxin B against polymyxin-resistant Escherichia coli cells. These results suggest that pairing adjuvants with antibiotics could be a useful general intervention against resistant bacteria, helping to mitigate the effects of antimicrobial resistance.