Synergistic Effects of Capric Acid and Colistin against Colistin-Susceptible and Colistin-Resistant <i>Enterobacterales</i>

Abstract

Colistin is a last-line antibiotic against Gram-negative pathogens. However, the emergence of colistin resistance has substantially reduced the clinical effectiveness of colistin. In this study, synergy between colistin and capric acid was examined against twenty-one Gram-negative bacterial isolates (four colistin-susceptible and seventeen colistin-resistant). Checkerboard assays showed a synergistic effect against all colistin-resistant strains [(FICI, fractional inhibitory concentration index) = 0.02–0.38] and two colistin-susceptible strains. Time–kill assays confirmed the combination was synergistic. We suggest that the combination of colistin and capric acid is a promising therapeutic strategy against Gram-negative colistin-resistant strains.

Keywords

• colistin resistance
• combination therapy
• capric acid
• synergy