Bacterial efflux pump inhibitors from natural sources

M Stavri, Laura Piddock, S Gibbons

Research output: Contribution to journalArticle

351 Citations (Scopus)


The rapid spread of bacteria expressing multidrug resistance (MDR) has necessitated the discovery of new antibacterials and resistance-modifying agents. Since the initial discovery of bacterial efflux pumps in the 1980s, many have been characterized in community- and hospital-acquired Gram-positive and Gram-negative pathogens, such as Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and, more recently, in mycobacteria. Efflux pumps are able to extrude structurally diverse compounds, including antibiotics used in a clinical setting; the latter are rendered therapeutically ineffective. Antibiotic resistance can develop rapidly through changes in the expression of efflux pumps, including changes to some antibiotics considered to be drugs of last resort. It is therefore imperative that new antibiotics, resistance-modifying agents and, more specifically, efflux pump inhibitors (EPIs) are characterized. The use of bacterial resistance modifiers such as EPIs could facilitate the re-introduction of therapeutically ineffective antibiotics back into clinical use such as ciprofloxacin and might even suppress the emergence of MDR strains. Here we review the literature on bacterial EPIs derived from natural sources, primarily those from plants. The resistance-modifying activities of many new chemical classes of EPIs warrant further studies to assess their potential as leads for clinical development.
Original languageEnglish
Pages (from-to)1247-60
Number of pages14
JournalJournal of Antimicrobial Chemotherapy
Issue number6
Early online date18 Apr 2007
Publication statusPublished - 18 Apr 2007


  • MDR
  • MRSA
  • Mycobacterium
  • modulators
  • Pseudomonas
  • Escherichia
  • Staphylococcus aureus
  • NorA
  • efflux


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