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Review
. 2022 Dec 21:10:1025633.
doi: 10.3389/fpubh.2022.1025633. eCollection 2022.

The resistance mechanisms of bacteria against ciprofloxacin and new approaches for enhancing the efficacy of this antibiotic

Aref Shariati  1 , Maniya Arshadi  2   3 , Mohammad Ali Khosrojerdi  4 , Mostafa Abedinzadeh  4 , Mahsa Ganjalishahi  4 , Abbas Maleki  5 , Mohsen Heidary  6   7 , Saeed Khoshnood  5   8
Affiliations
Review

The resistance mechanisms of bacteria against ciprofloxacin and new approaches for enhancing the efficacy of this antibiotic

Aref Shariati et al. Front Public Health. .

Abstract

For around three decades, the fluoroquinolone (FQ) antibiotic ciprofloxacin has been used to treat a range of diseases, including chronic otorrhea, endocarditis, lower respiratory tract, gastrointestinal, skin and soft tissue, and urinary tract infections. Ciprofloxacin's main mode of action is to stop DNA replication by blocking the A subunit of DNA gyrase and having an extra impact on the substances in cell walls. Available in intravenous and oral formulations, ciprofloxacin reaches therapeutic concentrations in the majority of tissues and bodily fluids with a low possibility for side effects. Despite the outstanding qualities of this antibiotic, Salmonella typhi, Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa have all shown an increase in ciprofloxacin resistance over time. The rise of infections that are resistant to ciprofloxacin shows that new pharmacological synergisms and derivatives are required. To this end, ciprofloxacin may be more effective against the biofilm community of microorganisms and multi-drug resistant isolates when combined with a variety of antibacterial agents, such as antibiotics from various classes, nanoparticles, natural products, bacteriophages, and photodynamic therapy. This review focuses on the resistance mechanisms of bacteria against ciprofloxacin and new approaches for enhancing its efficacy.

Keywords: antibacterial agents; ciprofloxacin; new approach; resistance; review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Chemical structure of ciprofloxacin (9).
Figure 2
Figure 2
Ciprofloxacin's mechanisms of action (13). Because ciprofloxacin blocks DNA gyrase and topoisomerase IV, DNA replication is slowed and double-stranded DNA breaks are created.
Figure 3
Figure 3
Mechanisms of ciprofloxacin resistance carried by plasmids (82). Genes encoding the ciprofloxacin efflux pumps can be found in plasmids. Aac(6')-Ib-cr, an aminoglycoside-modifying acetyltransferase that acetylates and inactivates ciprofloxacin, or QepA or OqxAB, the Qnr protein, which binds gyrase.
Figure 4
Figure 4
Used nano-platforms for enhancement of ciprofloxacin efficacy against bacteria. (A) Nanoparticles could boost the antibacterial function of ciprofloxacin by inhibition of efflux-pumps. (B) Nanoparticles increase the antibacterial activity and penetration of ciprofloxacin to the (B) dipper layers of biofilm and (C) body organs such as the skin.
Figure 5
Figure 5
The combination uses ciprofloxacin and other antibacterial agents.
See this image and copyright information in PMC

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