Antibacterial resistance poses a severe threat to public
health;
an anticipated 14-fold increase in multidrug-resistant (MDR) bacterial
infections is expected to occur by 2050. Contrary to antibiotics,
combination therapies are the standard of care for antiviral and anticancer
treatments, as synergistic drug–drug interactions can decrease
dosage and resistance development. In this study, we investigated
combination treatments of a novel succinate dehydrogenase inhibitor
(promysalin) with specific inhibitors of metabolism and efflux alongside
a panel of clinically approved antibiotics in synergy studies. Through
these investigations, we determined that promysalin can work synergistically
with vancomycin and antagonistically with aminoglycosides and a glyoxylate
shunt pathway inhibitor at subinhibitory concentrations; however,
these cooperative effects do not reduce minimum inhibitory concentrations.
The variability of these results underscores the complexity of targeting
metabolism for combination therapies in antibiotic development.