Potential for inhibition of bacterial efflux pumps in multidrug-resistant Vibrio cholera

The bacterium Vibrio cholerae is the causative agent of cholera, a severe gastrointestinal disease characterized primarily by the excretion of large amounts of the so-called rice water stool, which contains critical electrolytes and water. Cholera patients may succumb very quickly to the resulting severe dehydration producing significant morbidity and mortality rates. According to the World Health Organization (WHO), approximately 3-5 million cases of cholera occur each year with 100,000-120,000 yearly estimated deaths. Clearly, V. cholerae represents a critical public health concern . Key therapeutic efforts against cholera in humans include electrolyte replenishment, and for severe cholera cases, antimicrobial agents, such as tetracycline, furazolidone, ciprofloxacin, and trimethoprim-sulphamethoxazole [2] . Though antimicrobials shorten the duration of illness and reduce faecal shedding of V. cholerae, prolonged antimicrobial use results in the development of antimicrobial resistance. Strains of V. cholerae have emerged that are resistant not only to each of these antimicrobial agents but also to multiple drugs, further confounding treatment efforts against cholera.