ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
Synergistic and additive in vitro interactions of imipenem, trimethoprim-sulfamethoxazole, amikacin, and clofazimine against clinical isolates of Nocardia wallacei.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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1 citing paper in PubMed.
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2 authors.
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Abstract
Nocardia wallacei presents a therapeutic challenge due to its frequent in vitro resistance to commonly used antimicrobials, including trimethoprim-sulfamethoxazole (TMP-SMX), imipenem, and amikacin. Current nocardiosis treatment guidelines provide general recommendations but lack species-specific guidance for N. wallacei. Given the limited therapeutic options for this species, evaluating combination therapies may support treatment optimization. We assessed the potential synergistic and additive effects between TMP-SMX, imipenem, amikacin, and clofazimine using the checkerboard titration method in 16 clinical isolates. Synergy, defined by a Fractional Inhibitory Concentration Index (FICI) of 0.25-0.5, was observed when TMP-SMX was combined with amikacin, clofazimine, or imipenem. Clofazimine demonstrated additive activity when combined with imipenem or amikacin (FICI = 0.53-0.625). The amikacin-imipenem combination also yielded additive effects (FICI = 0.75-1). These findings suggest that multiple dual-drug combinations may enhance in vitro efficacy against N. wallacei despite reduced monotherapy activity.
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Registered trials
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