New roles of fluoxetine in pharmacology: Antibacterial effect and modulation of antibiotic activity

The antimicrobial activity of psychotropic drugs, especially those of the class of mainly phenothiazines has been previously reported. Other drugs, including verapamil and trifluoperazine demonstrated to be effective against multidrug-resistant strains. Selective serotonin reuptake inhibitors (SSRIs) are antidepressant drugs that have presented significant activity against resistant bacterial resistance, but the antibacterial effect as well the antibiotic modulating properties of fluoxetine remain to be elucidated. Therefore, the present study aimed to evaluate in vitro, the antibacterial effect and the antibiotic modulating activity of fluoxetine against standard and multiresistant bacterial strains. The microorganisms used were Pseudomonas aeruginosa, Staphylococcus aureus and Escherichia coli. For the antibacterial tests, 10 mg fluoxetine hydrochloride were and diluted in 1 mL of dimethyl sulfoxide (DMSO) and then diluted in sterile distilled water to a concentration of 1024 μg/mL. To determine the Minimum Inhibitory Concentrations (MICs), the drugs were diluted to concentrations ranging from 512 to 0.5 μg/mL in 96-well microdilution plates. The evaluation of the modulatory activity of fluoxetine was performed by combining this drug with the following antibiotics: Erythromycin, Gentamicin, Imipenem, Norfloxacin and Tetracycline at subinhibitory concentrations (MIC/8). Our results demonstrated that the MIC fluoxetine were 256 and 102 μg/mL against standard and resistant strains of S. aureus, respectively. The MIC of fluoxetine against both standard and resistant strains of P. aeruginosa was 161 μg/mL and against E. coli, the MIC of fluoxetine was 102 μg/mL for both standard and resistant strains, demonstrating that this drug present significant antibacterial activity. The association of fluoxetine with gentamicin and erythromycin P. aeruginosa and E. coli presented synergistic effects, demonstrating that this drug can selectively modulate the activity of antibiotics of clinical use. In conclusion, fluoxetine presented significant antibacterial effect and potential antibiotic modulating activity against multiresistant bacteria. Therefore, additional studies are needed to characterize the antimicrobial properties of this drug, as well as the clinical implications of its use in the treatment of infections by resistant microorganisms.