The aim of this study was to evaluate the effect of ciprofloxacin (CIP), N-acetylcysteine (NAC) alone and in combination on biofilm production and pre-formed mature biofilms on ureteral stent surfaces. Two strains each of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Klehseilla pneumoniae, Pseudomonas aeruginosa and Proteus vulgaris, recently isolated from patients undergoing ureteral stent removal and shown to be capable of biofilm production, were used in this study. The inhibitory effects of ciprofloxacin, N-acetylcysteine and ciprofloxacin/N-acetylcysteine combination were determined by static adherence assay. Ciprofloxacin (MIC and 2 MIC) and N-acetylcysteine (2 and 4 mg/ml) inhibited biofilm production by ≥60% in all tested microorganisms. Disruption of pre-formed biofilms of all tested microorganisms was found to be ≥78% in the presence of ciprofloxacin (MIC and 2 MIC) and ≥62% in the presence of N-acetylcysteine (2 and 4 mg/ml), compared to controls. Ciprofloxacin/N-acetylcysteine showed the highest inhibitory effect on biofilm production (94-100%) and the highest disruptive effect on the pre-formed biofilms (86-100%) in comparison to controls. N-acetylcysteine was found to increase the therapeutic efficacy of ciprofloxacin by degrading the extracellular polysaccharide matrix of biofilms. These data are statistically significant. The inhibitory effects of ciprofloxacin and N-acetylcysteine on biofilm production were also verified by scanning electron microscope (SEM). In conclusion, Ciprofloxacin/N-acetylcysteine combinations have the highest inhibitory effect on biofilm production and the highest ability to eradicate pre-formed mature biofilms.
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