title: Ciprofloxacin plus erythromycin or ambroxol ameliorates endotracheal tube-associated Pseudomonas aeruginosa biofilms in a rat model.
abstract: OBJECTIVE
  Pseudomonas aeruginosa is a multi-drug resistant bacterium, with its biofilm-growing mucoid (alginate-producing) strains being particularly resistant. As atomized drug administration is a common practice in pediatric patients, we compared the effect of inhalational therapy with erythromycin plus ciprofloxacin, with that of ambroxol plus ciprofloxacin, against biofilm producing strains of P. aeruginosa.
  
  
  RESULTS
  Both combined treatment regimens were associated with a significant reduction in bacterial counts in endotracheal (ET) tubes and lungs, as compared to that observed with ambroxol and erythromycin monotherapies (P<0.05). Ciprofloxacin plus ambroxol appeared to have a higher efficacy than ciprofloxacin plus erythromycin, both in lowering bacterial counts (P<0.05) and in disrupting the structural integrity of biofilm. Histopathological changes in the lungs were milder in the two combined treatment groups, as compared to that in groups treated with single drugs.
  
  
  CONCLUSIONS
  Erythromycin or ambroxol in combination with ciprofloxacin could eliminate P. aeruginosa biofilms. When combined with ciprofloxacin, ambroxol outperformed erythromycin in eradicating P. aeruginosa biofilm.
authors.affiliation: Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Cheng
authors.affiliation: The Children's Hospital, Zhejiang University School of Medicine, China.
authors.forename: Lizhong
authors.initials: L
authors.lastname: Du
authors.affiliation: Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China. Electronic address: familycheryl0923@gmail.com.
authors.forename: Jialin
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Lu
authors.affiliation: Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: He
authors.affiliation: Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Ran
mesh_terms: D000551:Ambroxol / Q000008:administration & dosage*; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D018441:Biofilms / Q000254:growth & development*; D002408:Catheters, Indwelling / Q000382:microbiology; D002939:Ciprofloxacin / Q000008:administration & dosage*; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D004917:Erythromycin / Q000008:administration & dosage*; D005260:Female; D008297:Male; D016459:Prosthesis-Related Infections / Q000382:microbiology; D011552:Pseudomonas Infections / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000502:physiology; D051381:Rats; D017207:Rats, Sprague-Dawley; D012121:Respiration, Artificial
chemical_list: D000900:Anti-Bacterial Agents; D000551:Ambroxol; D002939:Ciprofloxacin; D004917:Erythromycin
keywords: Ambroxol; Biofilm; Ciprofloxacin; Combination; Erythromycin; Pseudomonas aeruginosa