Journals / Sağlıkta Performans ve Kalite Dergisi / 2026 / Sayı: 23

ANTİBİYOTİK KOMBİNASYONLARININ AKILCI KULLANIMI VE BAKTERİYEL DİRENÇ ÜZERİNE ETKİSİ

Metin Deniz Karakoç(PAMUKKALE ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0003-3188-8738
Demet Döndü Kasım(PAMUKKALE ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0003-0343-1255
Pages
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Publication Date
2026-08-21
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Çalışmamızda, antibiyotik direncine karşı stratejiler güncel literatür ışığında kollateral duyarlılık, sinerjizma ve supresyon mekanizmaları açısından değerlendirilmiş ve antibiyotik-antibiyotik ile antibiyotik-antibiyotik dışı ilaç kombinasyonlarının olası terapötik uygulamaları olduğu sonucuna ulaşılmıştır.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:20. yüzyılın başlarında antibiyotiklerin keşfinden bu yana, insanlık tarihi açısından kısa sayılabilecek yüz yıl gibi bir süre içinde bakteriyel dirençte hızlı ve aşırı bir artış meydana gelmiştir.
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Key Findings & Data:Antibiyotiklerin keşif kronolojisindeki ilk 50 yıl ile kıyaslandığında, sonraki 50 yılda beşerî kullanıma sunulan yeni antibiyotik sayısının belirgin şekilde azaldığı görülmektedir.
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Conclusion & Impact:Çalışmamızda, antibiyotik direncine karşı stratejiler güncel literatür ışığında kollateral duyarlılık, sinerjizma ve supresyon mekanizmaları açısından değerlendirilmiş ve antibiyotik-antibiyotik ile antibiyotik-antibiyotik dışı ilaç kombinasyonlarının olası terapötik uygulamaları olduğu sonucuna ulaşılmıştır.
🔬Design:Review & Systematic Survey
📍Scope:Comprehensive Sample
⚙️Variables:Akılcı antibiyotik kullanımı · antibiyotik direnci · ilaç etkileşimleri

Özet

20. yüzyılın başlarında antibiyotiklerin keşfinden bu yana, insanlık tarihi açısından kısa sayılabilecek yüz yıl gibi bir süre içinde bakteriyel dirençte hızlı ve aşırı bir artış meydana gelmiştir. Bu durum günümüzde yaşamı tehdit eden küresel bir sağlık sorununa dönüşmüştür. Antibiyotiklerin keşif kronolojisindeki ilk 50 yıl ile kıyaslandığında, sonraki 50 yılda beşerî kullanıma sunulan yeni antibiyotik sayısının belirgin şekilde azaldığı görülmektedir. Son 20 yılda ise yeni antibiyotiklerin sayısı oldukça sınırlı kalmıştır. Bu durum, antibiyotik direnciyle mücadelede daha rasyonel yaklaşımların acilen geliştirilmesi gerektiğine işaret etmektedir. Çalışmamızda, antibiyotik direncine karşı stratejiler güncel literatür ışığında kollateral duyarlılık, sinerjizma ve supresyon mekanizmaları açısından değerlendirilmiş ve antibiyotik-antibiyotik ile antibiyotik-antibiyotik dışı ilaç kombinasyonlarının olası terapötik uygulamaları olduğu sonucuna ulaşılmıştır.

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Cite This Article

Karakoç, M. D., Kasım, D. D. (2026). ANTİBİYOTİK KOMBİNASYONLARININ AKILCI KULLANIMI VE BAKTERİYEL DİRENÇ ÜZERİNE ETKİSİ. Sağlıkta Performans ve Kalite Dergisi, Sayı: 23. https://doi.org/10.70915/spkd.1762688

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References (70)

  1. Antimicrobial Resistance Collaborators (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet (London, England), 399(10325), 629–655. https://doi.org/10.1016/S0140-6736(21)02724-0
  2. Barman, S., Kurnaz, L. B., Leighton, R., Hossain, M. W., Decho, A. W., & Tang, C. (2024). Intrinsic antimicrobial resistance: molecular biomaterials to combat microbial biofilms and bacterial persisters. Biomaterials, 311, 122690.
  3. Beckley, A. M., & Wright, E. S. (2021). Identification of antibiotic pairs that evade concurrent resistance via a retrospective analysis of antimicrobial susceptibility test results. The Lancet Microbe, 2(10), e545–e554.
  4. Beppler, C., Tekin, E., White, C., Mao, Z., Miller, J. H., Damoiseaux, R., Savage, V. M., & Yeh, P. J. (2017). When more is less: emergent suppressive interactions in three-drug combinations. BMC microbiology, 17(1), 107.
  5. Bhardwaj, S., Mehra, P., Dhanjal, D. S., Sharma, P., Sharma, V., Singh, R., Nepovimova, E., Chopra, C., & Kuča, K. (2022). Antibiotics and antibiotic resistance- flipsides of the same coin. Current Pharmaceutical Design, 28(28), 2312–2329. https://doi.org/10.2174/1381612828666220608120238
  6. Blanco-Cabra, N., Alcàcer-Almansa, J., Admella, J., Arévalo-Jaimes, B. V., & Torrents, E. (2024). Nanomedicine against biofilm infections: a roadmap of challenges and limitations. Wiley Interdisciplinary Reviews: Nanomedicine and Nanobiotechnology, 16(1), e1944. https://doi.org/10.1002/wnan.1944
  7. Brauner, A., Fridman, O., Gefen, O., & Balaban, N. Q. (2016). Distinguishing between resistance, tolerance and persistence to antibiotic treatment. Nature Reviews Microbiology, 14(5), 320–330.
  8. Brill, M. J. E., Kristoffersson, A. N., Zhao, C., Nielsen, E. I., & Friberg, L. E. (2018). Semi-mechanistic pharmacokinetic-pharmacodynamic modelling of antibiotic drug combinations. Clinical Microbiology and Infection, 24(7), 697–706.
  9. Burmeister, A. R., Fortier, A., Roush, C., Lessing, A. J., Bender, R. G., Barahman, R., Grant, R., Chan, B. K., & Turner, P. E. (2020). Pleiotropy complicates a trade-off between phage resistance and antibiotic resistance. Proceedings of the National Academy of Sciences of the United States of America, 117(21), 11207–11216. https://doi.org/10.1073/pnas.1919888117
  10. Cacace, E., Kim, V., Varik, V., Knopp, M., Tietgen, M., Brauer-Nikonow, A., Inecik, K., Mateus, A., Milanese, A., Mårli, M. T., Mitosch, K., Selkrig, J., Brochado, A. R., Kuipers, O. P., Kjos, M., Zeller, G., Savitski, M. M., Göttig, S., Huber, W., & Typas, A. (2023). Systematic analysis of drug combinations against gram-positive bacteria. Nature Microbiology, 8(11), 2196–2212. https://doi.org/10.1038/s41564-023-01486-9
  11. Calzetta, L., Page, C., Matera, M. G., Cazzola, M., & Rogliani, P. (2024). Drug-drug interactions and synergy: from pharmacological models to clinical application. Pharmacological Reviews, 76(6), 1159–1220. https://doi.org/10.1124/pharmrev.124.000951
  12. Carolus, H., Sofras, D., Boccarella, G., Jacobs, S., Biriukov, V., Goossens, L., Chen, A., Vantyghem, I., Verbeeck, T., Pierson, S., Lobo Romero, C., Steenackers, H., Lagrou, K., van den Berg, P., Berman, J., Gabaldón, T., & Van Dijck, P. (2024). Collateral sensitivity counteracts the evolution of antifungal drug resistance in Candida auris. Nature Microbiology, 9(11), 2954–2969. https://doi.org/10.1038/s41564-024-01811-w
  13. Cook, M. A., & Wright, G. D. (2022). The past, present, and future of antibiotics. Science Translational Medicine, 14(657), eabo7793.
  14. Czaplewski, L., Bax, R., Clokie, M., Dawson, M., Fairhead, H., Fischetti, V. A., … & Rex, J. H. (2016). Alternatives to antibiotics-a pipeline portfolio review. The Lancet Infectious Diseases, 16(2), 239–251. https://doi.org/10.1016/S1473-3099(15)00466-1
  15. Davido, B., Fellous, L., Lawrence, C., Maxime, V., Rottman, M., & Dinh, A. (2017). Ceftazidime-avibactam and aztreonam, an interesting strategy to overcome β-lactam resistance conferred by metallo-β-lactamases in Enterobacteriaceae and Pseudomonas aeruginosa. Antimicrobial Agents and Chemotherapy, 61(9), e01008-17. https://doi.org/10.1128/AAC.01008-17
  16. de Kraker, M. E., Stewardson, A. J., & Harbarth, S. (2016). Will 10 million people die a year due to antimicrobial resistance by 2050. PLoS Medicine, 13(11), e1002184. https://doi.org/10.1371/journal.pmed.1002184
  17. Durão, P., Balbontín, R., & Gordo, I. (2018). Evolutionary mechanisms shaping the maintenance of antibiotic resistance. Trends in Microbiology, 26(8), 677–691.
  18. Eljounaidi, K., & Lichman, B. R. (2020). Nature's Chemists: The discovery and engineering of phytochemical biosynthesis. Frontiers in Chemistry, 8, 596479.
  19. Evans, J., Hanoodi, M., & Wittler, M. (2024). Amoxicillin clavulanate. In StatPearls. StatPearls Publishing.
  20. Fallone, C. A., Chiba, N., van Zanten, S. V., Fischbach, L., Gisbert, J. P., Hunt, R. H., Jones, N. L., Render, C., Leontiadis, G. I., Moayyedi, P., & Marshall, J. K. (2016). The Toronto Consensus for the treatment of *Helicobacter pylori* infection in adults. Gastroenterology, 151(1), 51–69.e14.
  21. Ferreira, M., Pinto, M., Aires-da-Silva, F., Bettencourt, A., Gaspar, M. M., & Aguiar, S. I. (2024). Rifabutin: a repurposed antibiotic with high potential against planktonic and biofilm staphylococcal clinical isolates. Frontiers in Microbiology, 15, 1475124.
  22. Gelpi, A., Gilbertson, A., & Tucker, J. D. (2015). Magic bullet: Paul Ehrlich, salvarsan and the birth of venereology. Sexually Transmitted Infections, 91(1), 68–69.
  23. Gerber, J. S., Hersh, A. L., Kronman, M. P., Newland, J. G., Ross, R. K., & Metjian, T. A. (2017). Development and application of an antibiotic spectrum index for benchmarking antibiotic selection patterns across hospitals. Infection Control and Hospital Epidemiology, 38(8), 993–997.
  24. Giske, C. G., Turnidge, J., Cantón, R., Kahlmeter, G., & EUCAST Steering Committee (2022). Update from the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Journal of Clinical Microbiology, 60(3), e0027621.
  25. Herencias, C., Álvaro-Llorente, L., Ramiro-Martínez, P., Fernández-Calvet, A., Muñoz-Cazalla, A., DelaFuente, J., Graf, F. E., Jaraba-Soto, L., Castillo-Polo, J. A., Cantón, R., San Millán, Á., & Rodríguez-Beltrán, J. (2024). Β-lactamase expression induces collateral sensitivity in Escherichia coli. Nature Communications, 15(1), 4731.
  26. Herencias, C., Rodríguez-Beltrán, J., León-Sampedro, R., Alonso-Del Valle, A., Palkovičová, J., Cantón, R., & San Millán, Á. (2021). Collateral sensitivity associated with antibiotic resistance plasmids. eLife, 10, e65130.
  27. Hernando-Amado, S., Laborda, P., & Martínez, J. L. (2023). Tackling antibiotic resistance by inducing transient and robust collateral sensitivity. Nature Communications, 14(1), 1723.
  28. Hossain T. J. (2024). Methods for screening and evaluation of antimicrobial activity: a review of protocols, advantages, and limitations. European Journal of Microbiology & Immunology, 14(2), 97–115.
  29. Hu, X., Sun, L., Nie, T., Yang, Y., Wang, X., Pang, J., Lu, X., Li, X., Lu, Y., Li, C., Yang, X., Meng, Y., Li, G., & You, X. (2022). Evaluation of Agar Dilution Method in Susceptibility Testing of Polymyxins for *Enterobacteriaceae* and Non-Fermentative Rods: Advantages Compared to Broth Microdilution and Broth Macrodilution. Antibiotics (Basel, Switzerland), 11(10), 1392.
  30. Hutchings, M. I., Truman, A. W., & Wilkinson, B. (2019). Antibiotics: past, present and future. Current Opinion in Microbiology, 51, 72–80.
  31. Irving, S. E., Choudhury, N. R., & Corrigan, R. M. (2021). The stringent response and physiological roles of (pp)pGpp in bacteria. Nature Reviews Microbiology, 19(4), 256–271.
  32. Jackson, N., Czaplewski, L., & Piddock, L. J. V. (2018). Discovery and development of new antibacterial drugs: learning from experience. The Journal of Antimicrobial Chemotherapy, 73(6), 1452–1459.
  33. Katz, L., & Baltz, R. H. (2016). Natural product discovery: past, present, and future. Journal of Industrial Microbiology & Biotechnology, 43(2-3):155–176.
  34. Katzir, I., Cokol, M., Aldridge, B. B., & Alon, U. (2019). Prediction of ultra-high-order antibiotic combinations based on pairwise interactions. PLoS Computational Biology, 15(1), e1006774.
  35. Kim, S., Lieberman, T. D., & Kishony, R. (2014). Alternating antibiotic treatments constrain evolutionary paths to multidrug resistance. Proceedings of the National Academy of Sciences of the United States of America, 111(40), 14494–14499.
  36. Laborda, P., Martínez, J. L., & Hernando-Amado, S. (2022). Convergent phenotypic evolution towards fosfomycin collateral sensitivity of Pseudomonas aeruginosa antibiotic-resistant mutants. Microbial Biotechnology, 15(2), 613–629.
  37. Lázár, V., Snitser, O., Barkan, D., & Kishony, R. (2022). Antibiotic combinations reduce Staphylococcus aureus clearance. Nature, 610(7932), 540–546.
  38. Lee, S., Song, K. H., Jung, S. I., Park, W. B., Lee, S. H., Kim, Y. S., Kwak, Y. G., Kim, Y. K., Kiem, S. M., Kim, H. I., Kim, E. S., Park, K. H., Kim, N. J., Jang, H. C., Kim, H. B., & Korea Infectious Diseases (KIND) study group (2018). Comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus bacteraemia: a prospective multicentre cohort study in Korea. Clinical Microbiology and Infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 24(2), 152–158.
  39. Liu, H. Y., Prentice, E. L., & Webber, M. A. (2024). Mechanisms of antimicrobial resistance in biofilms. Npj Antimicrobials and Resistance, 2(1), 27.
  40. Liu, J., Gefen, O., Ronin, I., Bar-Meir, M., & Balaban, N. Q. (2020). Effect of tolerance on the evolution of antibiotic resistance under drug combinations. Science, 367(6474), 200–204.
  41. Ma, Z., & Lynch, A. S. (2016). Development of a dual-acting antibacterial agent (TNP-2092) for the treatment of persistent bacterial infections. Journal of Medicinal Chemistry, 59(14), 6645–6657.
  42. Maeda, T., & Furusawa, C. (2024). Laboratory evolution of antimicrobial resistance in bacteria to develop rational treatment strategies. Antibiotics (Basel, Switzerland), 13(1), 94.
  43. Maier, L., Goemans, C. V., Wirbel, J., Kuhn, M., Eberl, C., Pruteanu, M., Müller, P., Garcia-Santamarina, S., Cacace, E., Zhang, B., Gekeler, C., Banerjee, T., Anderson, E. E., Milanese, A., Löber, U., Forslund, S. K., Patil, K. R., Zimmermann, M., Stecher, B., Zeller, G., … & Typas, A. (2021). Unravelling the collateral damage of antibiotics on gut bacteria. Nature, 599(7883), 120–124.
  44. Maltas, J., & Wood, K. B. (2019). Pervasive and diverse collateral sensitivity profiles inform optimal strategies to limit antibiotic resistance. PLoS Biology, 17(10), e3000515.
  45. Meylan, S., Andrews, I. W., & Collins, J. J. (2018). Targeting antibiotic tolerance, pathogen by pathogen. Cell, 172(6), 1228–1238.
  46. Nahid, P., Dorman, S. E., Alipanah, N., Barry, P. M., Brozek, J. L., Cattamanchi, A., … & Vernon, A. (2016). Official American thoracic society/centers for disease control and prevention/infectious diseases society of America clinical practice guidelines: treatment of drug-susceptible tuberculosis. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 63(7), e147–e195.
  47. Niu, H., Gu, J., & Zhang, Y. (2024). Bacterial persisters: molecular mechanisms and therapeutic development. Signal Transduction and Targeted Therapy, 9(1), 174.
  48. Noto Guillen, M., Li, C., Rosener, B., & Mitchell, A. (2024). Antibacterial activity of nonantibiotics is orthogonal to standard antibiotics. Science, 384(6691), 93–100.
  49. Nyhoegen, C., Bonhoeffer, S., & Uecker, H. (2024). The many dimensions of combination therapy: How to combine antibiotics to limit resistance evolution. Evolutionary Applications, 17(8), e13764.
  50. Omollo, C., Singh, V., Kigondu, E., Wasuna, A., Agarwal, P., Moosa, A., Ioerger, T. R., Mizrahi, V., Chibale, K., & Warner, D. F. (2023). Developing synergistic drug combinations to restore antibiotic sensitivity in drug-resistant Mycobacterium tuberculosis. Antimicrobial Agents and Chemotherapy, 65(5), e02554-20.
  51. Pahil, K. S., Gilman, M. S. A., Baidin, V., Clairfeuille, T., Mattei, P., Bieniossek, C., Dey, F., Muri, D., Baettig, R., Lobritz, M., Bradley, K., Kruse, A. C., & Kahne, D. (2024). A new antibiotic traps lipopolysaccharide in its intermembrane transporter. Nature, 625(7995), 572–577.
  52. Pani, S., & Mohapatra, S. S. (2024). Phenotypic heterogeneity in bacteria: the rise of antibiotic persistence, clinical implications, and therapeutic opportunities. Archives of Microbiology, 206(11), 446.
  53. Parkins, M. D., Somayaji, R., & Waters, V. J. (2018). Epidemiology, Biology, and Impact of Clonal Pseudomonas aeruginosa Infections in Cystic Fibrosis. Clinical Microbiology Reviews, 31(4), e00019-18.
  54. Pettit, R. K., Weber, C. A., Lawrence, S. B., Pettit, G. R., Kean, M. J., & Cage, G. D. (2009). In vivo activity of anprocide alone, and in vitro activity in combination with conventional antibiotics against Staphylococcus aureus and Staphylococcus epidermidis biofilms. Journal of Medical Microbiology, 58(Pt 9):1203–1206.
  55. Pfaller, M. A., Huband, M. D., Mendes, R. E., Flamm, R. K., & Castanheira, M. (2018). In vitro activity of meropenem/vaborbactam and characterisation of carbapenem resistance mechanisms among carbapenem-resistant Enterobacteriaceae from the 2015 meropenem/vaborbactam surveillance programme. International Journal of Antimicrobial Agents, 52(2), 144–150.
  56. Podnecky, N. L., Fredheim, E. G. A., Kloos, J., Sørum, V., Primicerio, R., Roberts, A. P., Rozen, D. E., Samuelsen, Ø., & Johnsen, P. J. (2018). Conserved collateral antibiotic susceptibility networks in diverse clinical strains of Escherichia coli. Nature Communications, 9(1), 3673.
  57. Quan, D. H., Wang, T., Martinez, E., Kim, H. Y., Sintchenko, V., Britton, W. J., Triccas, J. A., & Alffenaar, J. W. (2025). Beta-lactam combination treatment overcomes rifampicin resistance in Mycobacterium tuberculosis. European journal of clinical microbiology ve infectious diseases: official publication of the European Society of Clinical Microbiology, 44(5), 1279–1284.
  58. Sakenova, N., Cacace, E., Orakov, A., Huber, F., Varik, V., Kritikos, G., Michiels, J., Bork, P., Cossart, P., Goemans, C. V., & Typas, A. (2025). Systematic mapping of antibiotic cross-resistance and collateral sensitivity with chemical genetics. Nature Microbiology, 10(1), 202–216.
  59. Shortridge, D., Pfaller, M. A., Castanheira, M., & Flamm, R. K. (2018). Antimicrobial activity of ceftolozane-tazobactam tested against Enterobacteriaceae and Pseudomonas aeruginosa with various resistance patterns isolated in U. S. hospitals (2013-2016) as part of the surveillance program: program to assess ceftolozane-tazobactam susceptibility. Microbial Drug Resistance, 24(5), 563–577.
  60. Singh, A., Amod, A., Pandey, P., Bose, P., Pingali, M. S., Shivalkar, S., Varadwaj, P. K., Sahoo, A. K., & Samanta, S. K. (2022). Bacterial biofilm infections, their resistance to antibiotics therapy and current treatment strategies. Biomedical Materials, 17(2), 10.1088/1748-605X/ac50f6.
  61. Singh, N., & Yeh, P. J. (2017). Suppressive drug combinations and their potential to combat antibiotic resistance. The Journal of Antibiotics, 70(11), 1033–1042.
  62. Torella, J. P., Chait, R., & Kishony, R. (2010). Optimal drug synergy in antimicrobial treatments. PLoS Computational Biology, 6(6), e1000796.
  63. Tyers, M., & Wright, G. D. (2019). Drug combinations: a strategy to extend the life of antibiotics in the 21st century. Nature Reviews Microbiology, 17(3), 141–155.
  64. Varache, M., Rizzo, S., Sayers, E. J., Newbury, L., Mason, A., Liao, C. T., Chiron, E., Bourdiec, N., Jones, A., Fraser, D. J., Taylor, P. R., Jones, A. T., Thomas, D. W., & Ferguson, E. L. (2024). Dextrin conjugation to colistin inhibits its toxicity, cellular uptake and acute kidney injury in vivo. RSC Pharmaceutics, 1(1), 68–79.
  65. Walsh, C. T., & Wencewicz, T. A. (2014). Prospects for new antibiotics: a molecule-centered perspective. The Journal of Antibiotics, 67(1), 7–22.
  66. Wang, L., Zhu, J., Chen, L., & Du, H. (2024). Cefiderocol: Clinical application and emergence of resistance. Drug Resistance Updates: Reviews and Commentaries in Antimicrobial and Anticancer Chemotherapy, 72, 101034.
  67. Wasan, H., Reeta, K. H., & Gupta, Y. K. (2024). Strategies to improve antibiotic access and a way forward for lower middle-income countries. The Journal of Antimicrobial Chemotherapy, 79(1), 1–10.
  68. Xu, W., Klumbys, E., Ang, E. L., & Zhao, H. (2019). Emerging molecular biology tools and strategies for engineering natural product biosynthesis. Metabolic Engineering Communications, 10, e00108.
  69. Zhang, K., Li, X., Yu, C., & Wang, Y. (2020). Promising Therapeutic Strategies Against Microbial Biofilm Challenges. Frontiers in Cellular and Infection Microbiology, 10, 359.
  70. Zhang, Y., Limaye, P. B., Renaud, H. J., & Klaassen, C. D. (2014). Effect of various antibiotics on modulation of intestinal microbiota and bile acid profile in mice. Toxicology and Applied Pharmacolog. 277(2):138–145.