The Resistance Mechanisms of Bacteria Against Ciprofloxacin and New Approaches for Enhancing the Efficacy of This Antibiotic

Ciprofloxacin, a fluoroquinolone antibiotic, has been effectively used for decades to treat various infections, but resistance has emerged in bacteria like Salmonella typhi, Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. This resistance necessitates new strategies to enhance ciprofloxacin's efficacy. Combining ciprofloxacin with other antibacterial agents, including different antibiotics, nanoparticles, natural products, bacteriophages, and photodynamic therapy, may improve its effectiveness against biofilm communities and multi-drug resistant strains. The review discusses these resistance mechanisms and potential synergistic approaches to counteract them.