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Background  Biofilm production is an important mechanism for bacterial survival and its association with antimicrobial resistance represents a challenge for the patient treatment. In this study we evaluated the  in vitro  action of macrolides in combination with anti-pseudomonal agents on biofilm-grown  Pseudomonas aeruginosa  recovered from cystic fibrosis (CF) patients .Results  A total of 64 isolates were analysed. The biofilm inhibitory concentration (BIC) results were consistently higher than those obtained by the conventional method, minimal inhibitory concentration, (MIC) for most anti-pseudomonal agents tested (ceftazidime:  P  = 0.001, tobramycin : P  = 0.001, imipenem:  P  < 0.001, meropenem:  P  = 0.005). When macrolides were associated with the anti-pseudomonal agents, the BIC values were reduced significantly for ceftazidime ( P <  0.001) and tobramycin ( P <  0.001), regardless the concentration of macrolides. Strong inhibitory quotient was observed when azithromycin at 8 mg/L was associated with all anti-pseudomonal agents tested in biofilm conditions.    Conclusions   P. aeruginosa  from CF patients within biofilms are highly resistant to antibiotics but macrolides proved to augment the  in vitro  activity of anti-pseudomonal agents.

bmc microbiology

Macrolides decrease the minimal inhibitory concentration of anti-pseudomonal agents against Pseudomonas aeruginosa from cystic fibrosis patients in biofilm