New approaches to target antibacterial agents toward
Gram-negative
bacteria are key, given the rise of antibiotic resistance. Since the
discovery of polymyxin B nonapeptide as a potent Gram-negative
outer membrane (OM)-permeabilizing synergist in the early 1980s, a
vast amount of literature on such synergists has been published. This
Review addresses a range of peptide-based and small organic compounds
that disrupt the OM to elicit a synergistic effect with antibiotics
that are otherwise inactive toward Gram-negative bacteria, with synergy
defined as a fractional inhibitory concentration index (FICI) of <0.5.
Another requirement for the inclusion of the synergists here covered
is their potentiation of a specific set of clinically used antibiotics:
erythromycin, rifampicin, novobiocin, or vancomycin. In addition,
we have focused on those synergists with reported activity against
Gram-negative members of the ESKAPE family of pathogens namely,
Escherichia coli
,
Pseudomonas aeruginosa
,
Klebsiella pneumoniae
, and/or
Acinetobacter
baumannii
. In cases where the FICI values were not directly
reported in the primary literature but could be calculated from the
published data, we have done so, allowing for more direct comparison
of potency with other synergists. We also address the hemolytic activity
of the various OM-disrupting synergists reported in the literature,
an effect that is often downplayed but is of key importance in assessing
the selectivity of such compounds for Gram-negative bacteria.