Activity and interaction of trimethoprim and sulphamethoxazole against Escherichia coli

The activity of trimethoprim (TMP) and sulphamethoxazole (SMX), alone and in combination, against a sensitive strain of Escherichia coli was investigated in turbidimetric systems. In a static system in which the conditions of exposure of bacteria to drug resembled those of conventional minimum inhibitory concentration (MIC) titrations, both TMP and SMX exhibited antibacterial activity at concentrations well below the conventionally determined MIC, but regrowth occured at these concentrations during the overnight incubation period due to the emergence of adaptively resistant bacteria. Tests of combined drug action in the static turbidimetric system revealed even more synergic interaction than was apparent in conventional MIC tests. It is suggested that an important component of overall synergic interaction is the mutual suppression of adaptive "resistance" to the other agent. Studies in an in vitro model which simulates the hydrokinetic features of the urinary bladder showed that concentrations of TMP and SMX below the conventionally determined MIC inhibited the growth even of extremely dense bacterial populations so long as the concentration of drug was maintained. The response of cultures exposed to combinations of TMP and SMX in this system was so dominated by the effect of TMP that no synergic interaction with SMX was noted at concentrations of the drugs which are achievable in urine.