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This study evaluated the antimicrobial activity of promethazine against  Staphylococcus aureus ,  Staphylococcus epidermidis  and  Streptococcus mutans  and its effect on the antimicrobial susceptibility of biofilms grown  in vitro  and  ex vivo  on porcine heart valves. Promethazine was evaluated alone and in combination with vancomycin and oxacillin against  Staphylococcus  spp. and vancomycin and ceftriaxone against  S. mutans  in planktonic form and biofilms grown  in vitro  and  ex vivo . Promethazine minimum inhibitory concentration range was 24.4-95.31 μg/mL and minimum biofilm eradication concentration range was 781.25-3.125 μg/mL. Promethazine interacted synergistically with vancomycin, oxacillin and ceftriaxone against biofilms  in vitro . Promethazine alone reduced ( p  &lt; 0.05) the CFU-counts of biofilms grown on heart valves for  Staphylococcus  spp., but not for  S. mutans , and increased ( p  &lt; 0.05) the activity of vancomycin, oxacillin and ceftriaxone against biofilms of Gram-positive cocci grown  ex vivo . These findings bring perspectives for repurposing promethazine as adjuvant in the treatment of infective endocarditis.

Effect of promethazine on biofilms of gram-positive cocci associated with infectious endocarditis