# Antimicrobial and Anti-Efflux Machinery of FDA-Approved Proton Pump Inhibitors and Vitamins Against Klebsiella pneumoniae and Pseudomonas aeruginosa

## TL;DR

This study shows that certain proton pump inhibitors and vitamins can block bacterial efflux pumps, making antibiotics more effective against drug-resistant bacteria.

## Contribution

The study demonstrates that vitamins D and K, along with proton pump inhibitors, inhibit bacterial efflux pumps and enhance antibiotic efficacy.

## Key findings

- Vitamins D and K significantly reduced the minimum inhibitory concentration of ciprofloxacin by 64-fold.
- Omeprazole decreased the expression of efflux-encoding genes acrB and mexA by 91.5% and 99.7%, respectively.

## Abstract

Background: The efflux system is one of the resistance mechanisms that bacteria use to reduce the effectiveness of antibiotics, leading to the development of multidrug resistance. To evaluate other treatment choices, esomeprazole (ESO), omeprazole (OME), pantoprazole (PAN), vitamin D (VD), and vitamin K (VK) were tested for potential efflux pump (EP)-inhibiting activity. Methods: The minimum inhibitory concentrations (MICs) of the tested drugs were determined against K. pneumoniae ATCC 51503 and P. aeruginosa PAO1. Quantitative estimation of the EP-inhibiting activity of the tested medications was phenotypically investigated with a semi-automated fluorometric system and genotypically confirmed by real-time polymerase chain reaction (RT-PCR). Data were confirmed through docking study. Results: K. pneumoniae ATCC 51503 and P. aeruginosa PAO1 were positive efflux standard strains. VD and VK revealed an MICVD of 625–1250 µg/mL and MICVK of 2500–5000 µg/mL, lower than what was detected for PPIs (MICPPIs = 16,000–32,000 µg/mL). Vitamins showed powerful anti-efflux activity with remarkable ethidium bromide accumulation in K. pneumoniae ATCC 51503 and P. aeruginosa PAO1. Also, VD and VK significantly lowered the MIC of ciprofloxacin by 64-fold. On the molecular level, OME showed a notable decrease in the relative expression of the efflux-encoding genes acrB and mexA by 91.5% and 99.7% in ATCC 51503 and PAO1, respectively. Conclusion: This study highlights the anti-efflux activity of ESO, OME, PAN, VD, and VK against the tested Gram-negative strains. Hence, these PPIs and vitamins could be valuable adjuvant treatments to enhance the effectiveness of curing infections caused by MDR strains.