Bactericidal synergy between penicillin or ampicillin and aminoglycosides against antibiotic-tolerant lactobacilli

The bactericidal activities of penicillin G and ampicillin alone were compared with those of their combinations with streptomycin or gentamicin against 17 strains of lactobacilli classified as tolerant to various beta-lactam antibiotics. The penicillin G combinations with streptomycin and gentamicin were synergistic against 17 and 16 of these strains, respectively, whereas the corresponding ampicillin-aminoglycoside combinations were synergistic against 12 and 15 strains, respectively. Importantly, synergy was manifested at concentrations of these antibiotics that are attained in serum after their administration in conventional dose regimens. In no instances were combinations antagonistic. These in vitro observations provide a partial explanation for the favorable results obtained in preliminary clinical evaluations of the benefits of combination regimens in the treatment of lactobacillus infections refractory to single-drug therapy.