Exploiting the antivirulence efficacy of an ajoene-ciprofloxacin combination against <i>Pseudomonas aeruginosa</i> biofilm associated murine acute pyelonephritis

The study investigated the <i>in vitro</i>, <i>ex vivo</i> and <i>in vivo</i> efficacy of ajoene and ciprofloxacin (CIP) alone and in combination against <i>Pseudomonas aeruginosa</i> biofilms and biofilm-associated murine acute pyelonephritis. The ajoene–CIP combination exhibited significant greater (<i>p</i> &lt; 0.05) antimotility and biofilm inhibitory effects than those obtained when they were applied individually. The combined action of the agents resulted in a significant increase in serum sensitivity and phagocytic uptake and killing of <i>P. aeruginosa</i> (<i>p</i> &lt; 0.001) compared to the untreated control. Mice groups treated with an ajoene (25 mg kg⁻¹) and CIP (30 mg kg⁻¹ or 15 mg kg⁻¹) combination showed a significantly (<i>p</i> &lt; 0.001) reduced bacterial load in the kidney and bladder as compared to that of infected controls and mice treated with solo agents on the fifth day post-infection. The decreased levels of biomarkers and photomicrographs of the kidney tissue of the treated mice showed a reduced severity of damage. Hence, the study highlights the antivirulent and therapeutic efficacy of the ajoene-CIP combination at the minimal dosage of CIP.