Repurposing Non-Infectious Therapeutic Agents to Aid in the Treatment of Chronic Biofilm Infections

Antibiotics primarily exert their effect on planktonic microbial states, limiting their ability to eradicate biofilms commonly seen in chronic infections. This is because the minimal inhibitory concentration of antibiotics needed to kill microbes in biofilms can be up to 1000 times greater than when microbes are in their planktonic state. Yet up to 70% of all chronic infections are associated with a biofilm component. Consequently, novel therapeutics are needed to aid in the treatment of chronic biofilm infections. One such approach is to repurpose drugs that have demonstrated safety for non-infectious clinical indications. The main advantage of this approach is that the agents have already been shown to be safe for human administration, which can expedite clinical trial development of agents for biofilm infections. Unfortunately, most clinicians are unaware of the antimicrobial properties of some commonly used drugs. Thus, the aim of this Perspective was to discuss the potential of four drugs that have theoretical promise as adjuvants in the treatment of chronic biofilm infections. This was accomplished by providing detailed discussion of each agent with respect to current clinical use, potential mechanisms of antimicrobial activity, and present data to support use as adjuvant biofilm agents.