Synergistic Activity of Niclosamide in Combination With Colistin Against Colistin-Susceptible and Colistin-Resistant Acinetobacter baumannii and Klebsiella pneumoniae

Abstract

Colistin is among the few antibiotics effective against multidrug-resistant <i>Acinetobacter baumannii</i> and <i>Klebsiella pneumoniae</i> clinical isolates. However, in the last few years, colistin-resistant <i>A. baumannii</i> and <i>K. pneumoniae</i> strains have emerged. Therefore, combination therapies, between colistin and other old drugs, restoring the activity of colistin are required. The main objective of this study was to analyse the activity of niclosamide, an anthelmintic drug, in combination with colistin against colistin-susceptible (Col-S) and colistin-resistant (Col-R) <i>A. baumannii</i> and <i>K. pneumoniae</i>. The MIC were determined by microdilution assay and the time-kill curves were performed. The zeta potential of Col-S and Col-R of <i>A. baumannii</i> and <i>K. pneumoniae</i> in presence of niclosamide was assessed. Niclosamide in combination with colistin showed improved activity against Col-S and Col-R <i>A. baumannii</i> and <i>K. pneumoniae</i>. Time-killing curves showed synergic activity between niclosamide and colistin against Col-S and Col-R <i>A. baumannii</i> and <i>K. pneumoniae</i>, especially when niclosamide or colistin was added for second time at 4 h of the 24 h killing curve. Col-R <i>A. baumannii</i> and <i>K. pneumoniae</i> in presence of niclosamide exhibited a greater negative charge (-34.95 ± 0.35 mV and -38.85 ± 0.92 mV; <i>P</i> < 0.05) than Col-R <i>A. baumannii</i> and <i>K. pneumoniae</i> in absence of niclosamide (-26.85 ± 3.65 mV and -35.27 ± 0.72 mV). These data suggest that niclosamide might be combined with colistin, being a potential alternative for treatment of Col-R Gram-negative bacilli infections.