~ 235 ~ The Pharma Innovation Journal 2020; 9(11): 235-240 ISSN (E): 2277- 7695 ISSN (P): 2349-8242 NAAS Rating: 5.03 TPI 2020; 9(11): 235-240 © 2020 TPI www.thepharmajournal.com Received: 18-09-2020 Accepted: 22-10-2020 Janus A Department of Veterinary Epidemiology & Preventive Medicine, College of Veterinary and Animal Sciences, Pookode, Wayand, Kerala, India Deepa PM Department of Veterinary Epidemiology & Preventive Medicine, College of Veterinary and Animal Sciences, Pookode, Wayand, Kerala, India Biju P Habeeb Department of Veterinary Clinical Medicine, Ethics & Jurisprudence, College of Veterinary and Animal Sciences, Pookode, Wayand, Kerala, India Jess Vergis Department of Veterinary Public Health, College of Veterinary and Animal Sciences, Pookode, Wayand, Kerala, India Corresponding Author: Janus A Department of Veterinary Epidemiology & Preventive Medicine, College of Veterinary and Animal Sciences, Pookode, Wayand, Kerala, India Antibiotic adjuvants as a novel strategy to tackle antibiotic resistance Janus A, Deepa PM, Biju P Habeeb and Jess Vergis Abstract Today antimicrobial resistance is considered as one of the most important threat to global health. So it is very crucial to identify measures to overcome the different mechanisms of antibiotic resistance. Among the major approaches to tackle Antibiotic resistance, antibiotic adjuvant strategies play an important role. The antibiotic adjuvant combinations that attained clinical success include β lactamase inhibitors, efflux pump inhibitors, outer membrane permiabilisers, virulence inhibitors and nanoparticles. Preclinical and clinical trials on these different approaches are going on. Keywords: Antimicrobial resistance, antibiotic adjuvant strategies, β lactamase inhibitors, efflux pump inhibitors, outer membrane permiabilisers, virulence inhibitors and nanoparticles 1. Introduction Discovery of antibiotics has been considered as the one of the most relevant contributions of the 20 th century. With the use of antimicrobials, a number of infectious diseases were controlled and even eradicated. But the overuse or misuse of these antibiotics in human beings, has led to the emergence of antibiotic resistance [1] . The problem of antibiotic resistance is equally important in animals as antibiotics are used extensively in them as therapeutic, prophylactic or as a growth promoter [2] . Widespread usage of antibiotics resulted in a selection pressure for bacteria to develop mutations or acquire resistance genes [3] . Today antimicrobial resistance is considered as one of the most important threat to global health [4] . Resistance can be divided in to two groups, intrinsic resistance or acquired resistance. While intrinsic resistance is due to the absence of targets to the antibiotics, acquired resistance is due to casual mutations or through acquisition of external genetic material. Horizontal gene exchange occurs through plasmids or transposons. Bacteria develop resistance to antibiotics through different mechanisms 1. Altering drug uptake by changes in the outer membrane permeability 2. Expression of efflux pumps for pumping out antibiotics 3. Modification of the drug target 4. Enzymatic inactivation of antibiotics to make them inactive 5. Through virulence factors [5] . 2. Current scenario World Health Organizaion (WHO) recently published an extensive list of antimicrobial resistant bacteria and the resistance level is very high in the case of almost all the clinically relevant bacteria. These bacteria are resistant to almost all antibiotics in the current pipeline. So it is very crucial to identify measures to overcome the different mechanisms of antibiotic resistance. The global consumption of antimicrobials in livestock was estimated to be 63,151 units in 2010. India accounts for 3% of the global consumption and is the fourth highest in the world. At 12.9x10 9 units of antibiotics consumed in 2010, India was the largest consumer of antibiotics for human health [6] . In January 2010, Food Safety and Standards Authority of India (FSSAI) limited the use of antibiotics in livestock rearing. An indicator of the rising tide of AMR in India is the rapidly increasing proportion of isolates of Staphylococcus aureusthat are resistant to methicillin. In 2008, about 29% of isolates were of methicillin - resistant Staphylococcus aureus (MRSA), and by 2014, this had risen to 47% [7] . Presence of antimicrobial residues in food animal products were reported from different parts of India [8] . Similaror related bacterial strains of animal origin were reported in human population [9] . Vancomycin resistant S. Aureusisolated from milk samples[10] Gram negative organisms were isolated from milk samples among cattle suffering from mastitis, of which 48% were ESBL producers [11] .