Modulation of exogenous antibiotic activity by host cathelicidin LL-37

The increasing number of infections caused by drug-resistant bacteria has spurred efforts to develop new therapeutic strategies. When applied locally, exogenous antibiotics work in an environment rich in endogenous antibacterial molecules such as the cathelicidin peptide LL-37, which has increased expression at infection sites because of the stimulatory effects of bacterial wall products on neutrophils and other cell types. To test for possible additive effects of exogenous and endogenous antibacterial agents, we evaluated the minimal inhibitory concentration (MIC) to assess the antibacterial activity of amoxicillin with clavulanic acid (AMC), tetracycline (T), erythromycin (E) and amikacin (AN) against different clinical isolates of Staphyloccocus aureus in combination with synthetic LL-37. These studies revealed that the antibacterial activity of AMC was strongly potentiated when added in combination with LL-37. However, in the presence of LL-37, we did not observe any decrease in the MIC values of T and E, particularly against methicillin-resistant S. aureus and macrolide-lincosamide-streptogramin B (MLS(B))(+)/β-lactamase (+) strains, indicating a lack of synergistic action between these molecules. Interaction between exogenous antibiotics and host antibacterial molecules should be considered to provide optimal treatment, especially in cases of topical infections accompanied by increasing expression of host antibacterial molecules.