Antibiotic Adjuvants and Their Synergistic Activity Against ESKAPE Pathogens

ESAKPE pathogens are acquiring resistance to the conventional and modern therapeutic strategies, becoming difficult to eradicate. The development of antibiotic resistant strains and their evolving escape process are one of the major global health concerns. The multidrug resistance mechanism and virulence pathways exhibited by ESKAPE pathogens urge the medical system to find effective alternatives to fight these pathogens. These pathogens exhibit resistance towards antibiotics by different mechanisms; drug modifications, drug efflux, target modifications, and decreased penetration through cell membrane. To combat antibiotic resistance, new antibiotics and antibacterial agents are explored from plant and bacterial sources. Recently, ESKAPE pathogens exhibited resistance towards these novel compounds or therapeutics. Alternative and effective therapeutics such as antibiotic combinations or in combination with adjuvants are in clinical trials. In recent years, antibiotic adjuvants used against ESKPE pathogens showed promising results as the development of resistance towards multiple agents is less. Also, the toxicity of drugs used in single therapy can be minimized when synergistic effect of drugs is displayed. In addition, more activity is expected in synergy in comparison to the monotherapy. Also, adjuvants especially from plant sources help to make the ineffective drugs to effective against the pathogens.