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Updated: Jul 1, 2026

Quadruple-Checkerboard: A Modification of the Three-Dimensional Checkerboard for Studying Drug Combinations

Quadruple-Checkerboard: A Modification of the Three-Dimensional Checkerboard for Studying Drug Combinations

Published on: July 24, 2021

[Optimization of antibiotics in combination].

Li-Hua Zhang¹, Ling-Feng Wang, Zhao-Yan Meng

¹Department of Pharmacy, Third Affiliated Hospital of Inner Mongolia Medical College, Baotou 014010, PR China.

Zhonghua Shao Shang Za Zhi = Zhonghua Shaoshang Zazhi = Chinese Journal of Burns

|September 13, 2008

Summary

Combining antibiotics like amikacin and ceftazidime enhances antibacterial activity against Pseudomonas aeruginosa. Pharmacokinetic/pharmacodynamic analysis helps optimize treatment regimens for improved clinical efficacy.

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Antimicrobial Synergy Testing by the Inkjet Printer-assisted Automated Checkerboard Array and the Manual Time-kill Method

Antimicrobial Synergy Testing by the Inkjet Printer-assisted Automated Checkerboard Array and the Manual Time-kill Method

Published on: April 18, 2019

Area of Science:

Microbiology
Pharmacology
Infectious Diseases

Background:

Pseudomonas aeruginosa is a significant opportunistic pathogen.
Antibiotic resistance necessitates novel treatment strategies.
Combination therapy is a key approach to combat resistant bacteria.

Purpose of the Study:

To evaluate in vitro antibacterial activity of Ciprofloxacin and Amikacin combined with beta-lactams against Pseudomonas aeruginosa.
To optimize antibiotic treatment regimens using pharmacokinetic/pharmacodynamic (PK/PD) principles and drug sensitivity testing.

Main Methods:

Checkerboard titration and broth dilution methods were used to determine minimal inhibitory concentrations (MICs).
Fractional inhibitory concentration (FIC) index was calculated to assess synergistic effects.
Pharmacokinetic/pharmacodynamic (PK/PD) parameters (Cmax/MIC and T>MIC) were evaluated.

Main Results:

Amikacin and Ceftazidime combination demonstrated synergistic effects in 57.6% of strains.
Ciprofloxacin combined with Ceftazidime, Cefepime, Imipenem/Cilastatin, or Meropenem showed synergistic or additive effects.
PK/PD evaluation identified Cmax/MIC for aminoglycosides/fluoroquinolones and T>MIC for beta-lactams as key parameters.

Conclusions:

Antibiotic combinations significantly reduce MICs and enhance antibacterial activity.
Combinations primarily result in synergistic or additive effects, with no observed antagonistic effects.
PK/PD analysis is crucial for planning optimal combination regimens and improving clinical outcomes.