Bacterial Cell Wall Synthesis Research Articles

Antibacterial Potential of Tetrahydrocarbazoles (THCZ): A Review

: Antibiotic resistance has become a major public threat across the globe associated with human health. Some bacterial and fungal infections produce resistance, such as methicillinresistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium (VRE) and multidrug-resistant (MDR) species Acinetobacter baumannii etc. Tetrahydrocarbazoles (THCz) are a sub-class of indole alkaloids profoundly present in natural products and biologically active compounds and have displayed potential biological activities in literature. THCz exhibit potential antibacterial activities through major bacterial pathways like cell wall synthesis inhibition and DNA gyrase enzyme inhibition with DNA sliding clamp inhibitors and MreB inhibitors. These THCZ also showed significant in vitro antibacterial activities against bacterial-resistant species, such as MRSA, VRE and Acinetobacter baumannii (MDR) in literature. MTDL (Multi Target Direct ligand) approach has been significantly used for the design of THC motif-based antibacterial agents. In this review article, we collected literature on THCz as a potential antibacterial agent from 2014 to date. The review study of THC core-based derivatives found excellent in vitro antibacterial profiles and revealed that they can play a significant role in drug discovery and the development of new antibiotics against various infectious diseases.

RESISTÊNCIA A BETALACTÂMICOS: UMA REVISÃO SISTEMÁTICA DOS MECANISMOS E IMPLICAÇÕES CLÍNICAS

Introduction: Beta-lactam antibiotics are commonly administered drugs for the treatment of bacterial infections. They act as inhibitors of bacterial cell wall synthesis, which is essential for the bacteria's survival. Bacterial resistance, especially to the class of β-lactam antibiotics, is a growing public health problem that impacts the efficacy of treatments and increases hospital costs. Objective: This work aims to conduct a systematic review on beta-lactam resistance, addressing its mechanisms and clinical implications. Methods: A systematic review was conducted following PRISMA criteria, selecting 15 complete articles published between 2014 and 2024, obtained from the BVS and MedLine databases. The articles were critically analyzed, and relevant data were organized into tables to discuss antibiotic resistance to β-lactams and address its causes, mechanisms, and clinical implications. Results: The reviewed studies indicated that bacterial resistance is influenced by genetic factors and interactions with the intestinal microbiota, in addition to the inappropriate use of antibiotics. Innovative interventions are necessary to address resistance, focusing on specific strains and mechanisms of action. Conclusion: Bacterial resistance requires a multifaceted approach, including an understanding of the mechanisms involved and the implementation of new treatment strategies. The research highlights the importance of effective interventions to combat resistant infections and improve clinical outcomes.

Host-Pathogen Interactions in Mycobacterium tuberculosis: Molecular Mechanisms and Implications for Treatment

Worldwide, tuberculosis (TB) due to Mycobacterium tuberculosis is a major public health problem with high morbidity and mortality. This review reviewed the molecular mechanisms and their implications for treatment of M. tuberculosis infection, as well as the complex host pathogen interactions underpinning M. tuberculosis infection. The ability of the pathogen to avoid the host immune responses by utilizing critical strategies for the evasion, for instance, inhibition of phagosome-lyosome fusion and modulation of the host cell pathways are discussed first. T cells play a critical role in the adaptive immune response, and granulomas develop, which are then examined in detail. It importantly informs current treatment protocols which struggle to overcome issues of patient compliance, drug resistance and toxicity. Explored are novel therapeutic approaches targeting bacterial cell wall synthesis, virulence factors and the use of host directed therapies. Recent advances in the development of vaccines, including the innovative endeavors that hope to improve or replace the BCG vaccine, are also reviewed. The review ends by anticipating future directions in TB management, which could be facilitated through efforts related to personalized medicine, and combination therapies, as well as rapid diagnostics to change how we think about treatment. The insights from this study are important for developing novel strategies to fight TB and to bring down its burden globally.

Design, Synthesis, and Molecular Docking Analysis of 4‐Quinolone‐2‐Carboxylic Acid Derivatives as Antimicrobial Agents

AbstractQuinolones represent a class of potent antibacterial agents that primarily function by inhibiting bacterial topoisomerases and DNA gyrase. A crucial feature of their structure is a carboxylic acid group at the C‐3 position, which facilitates interaction with the active sites of these enzymes. Since the mid‐20th century, the emergence and proliferation of antimicrobial resistance (AMR) have posed significant challenges in society, necessitating the development of novel therapeutic agents. In this context, a new series of quinolone derivatives has been designed and synthesized based on transtorine. All synthesized compounds were tested against both Gram‐positive and Gram‐negative bacteria, as well as three fungal strains. Among the new compounds, 5a, 5d, and 5f demonstrated superior activity against Gram‐negative bacteria, with 5a showing notable effectiveness against P. aeruginosa compared to ciprofloxacin and norfloxacin. However, none of the compounds exhibited activity against fungal strains. Molecular docking studies revealed that compound 5a inhibited five bacterial proteins, primarily targeting bacterial cell wall synthesis. Additionally, ADMET parameters indicated that the promising compounds are suitable for oral administration with limited penetration across the blood–brain barrier compared to existing standards. This research indicates a potential pathway for developing new quinolone‐based antibiotics in the fight against AMR.

Unveiling MurM inhibitors in Enterococcus faecalis V583: a promising approach to tackle antibiotic resistance

Enterococcus faecalis is commonly found in the GI tract of humans and animals. It causes various infections, especially in hospital environments, and shows growing antibiotic resistance. This study utilized a subtractive proteomics approach to find out the potential drug targets in E. faecalis. Unique metabolic pathways were analysed and compared to the host to minimize adverse effects. Among twenty nine pathogenic specific and seventy three host-pathogen common pathways identified using the KEGG database, sixty seven essential proteins were found through the DEG BLAST search. PSORTB predicted that forty cytoplasmic proteins could be suitable as druggable targets. Further analysis identified fourteen proteins with virulence properties using the VFDB BLAST. Among these, seven proteins with more than ten antigenic sites were subjected to DrugBank BLAST, identifying three novel and four existing drug targets. One of the crucial drug targets, MurM, was selected due to its critical role in peptidoglycan biosynthesis. The reason for selecting MurM is crucial for addressing antibiotic resistance, disrupting bacterial cell wall synthesis, and attaining selective antimicrobial activity. MurM belongs to the mixed αβ class with two functional domains. The possible binding site residues of MurM are Trp31, Lys35, Trp38, Arg215, and Tyr219. Virtual screening identified potential lead candidates for MurM, and four were selected based on their physiochemical, pharmacokinetic, and structural properties. This study provides valuable insights into identifying and analysing a potential drug target, the MurM protein, and its inhibitors in E. faecalis V583.

Unveiling the antibacterial potential of anthocyanins - a comprehensive review on this natural plant extract.

With the gradual prohibition of antibiotic fungicides, it is of great significance to develop high-efficient, nontoxic and environmental-friendly antimicrobial agents. Anthocyanin is a natural plant polyphenol pigment which shows antibacterial, anti-inflammatory and antioxidant effects through inhibiting the synthesis of bacterial cell wall, interfering bacterial respiratory metabolism, and inducing bacterial autolysis. As a typical antibacterial agent, anthocyanins have been widely used in various fields, including biological pesticides or feed additives in agricultural production, anti-inflammatory and antibacterial wound dressings in medicine, etc. However, the structure of anthocyanins is unstable, which limits its practical application. In this article, the biological activity, antibacterial mechanism and stabilization strategy of anthocyanins as antibacterial agents were reviewed. The safety, application scope and methods of anthocyanins were discussed. In addition, the challenges and development prospects of anthocyanin extract antibacterial technology were also prospected. This will be the direction for researchers to further explore and better apply anthocyanins to practical production and application.

Fully closed conformation of penicillin-binding protein revealed by structure of PBP2 from Acinetobacter baumannii

Penicillin-binding protein 2 (PBP2), a vital protein involved in bacterial cell-wall synthesis, serves a target for β-lactam antibiotics. Acinetobacter baumannii is a pathogen notorious for multidrug resistance; therefore, exploration of PBPs is pivotal in the development of new antimicrobial strategies. In this study, the tertiary structure of PBP2 from A. baumannii (abPBP2) was elucidated using X-ray crystallography. The structural analysis demonstrated notable movement in the head domain, potentially critical for its glycosyltransferase function, suggesting that abPBP2 assumes a fully closed conformation. Our findings offer valuable information for developing novel antimicrobial agents targeting abPBP2 that are applicable in combating multidrug-resistant infections.

Detection of Antibiotic Resistance among Gram-Negative Bacteria Isolated from Urinary Tract Infections

This study showed all isolates of bacteria are identified by many testes , such as morphological, biochemical, and API20E testes, as, the results confirmed that the Gram-negative bacteria in Thi-Qar government during the period of June and July 2023-2024. A total of 60 non-duplicate urine samples from patients are collected and examined for detection of Gram-negative bacteria. The results show that out of 60 urine samples 35(58.33%) samples are positive for bacterial growth of Gram negative. The results of bacterial diagnosis depending on testing showed that the frequency of bacterial pathogens thatause UTI as the following 15 (42.85%) are Escherichia coli,7 (20.0%) Enterobacter cloacae, 5 (14.28%) Klebsiella pneumonia, 3 (8.57 %) are from each of Proteus mirabilis and Pseudomonas aeruginosa, and 2 (4.76%) are Citrobacter spp. Antibiotics were divided into three categories that work on (nucleic acid, protein inhibition ,and bacterial cell wall synthesis) and the three groups were compared with each other .It was concluded which of them was more effective and performed better in eliminating bacteria and the results appeared as follows: Gram negative bacteria showed 91.42 % resistance to ampicillin 85.7% resistance to amikacin, 65.71% resistance to levofloxacin, 45.71% resistance to Norfloxacin, 31.42 % resistance to azithromycin and 13.37% resistance to ciprofloxacin.

Host defence peptide plectasin targets bacterial cell wall precursor lipid II by a calcium-sensitive supramolecular mechanism

Antimicrobial resistance is a leading cause of mortality, calling for the development of new antibiotics. The fungal antibiotic plectasin is a eukaryotic host defence peptide that blocks bacterial cell wall synthesis. Here, using a combination of solid-state nuclear magnetic resonance, atomic force microscopy and activity assays, we show that plectasin uses a calcium-sensitive supramolecular killing mechanism. Efficient and selective binding of the target lipid II, a cell wall precursor with an irreplaceable pyrophosphate, is achieved by the oligomerization of plectasin into dense supra-structures that only form on bacterial membranes that comprise lipid II. Oligomerization and target binding of plectasin are interdependent and are enhanced by the coordination of calcium ions to plectasin’s prominent anionic patch, causing allosteric changes that markedly improve the activity of the antibiotic. Structural knowledge of how host defence peptides impair cell wall synthesis will likely enable the development of superior drug candidates.

Comparison of broth microdilution and E-test for susceptibility of MRSA to vancomycin

Introduction: Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) developed soon after the introduction of methicillin. These bacteria have shown resistance to multiple drugs and therefore vancomycin became the antibiotic of choice for treatment of MRSA infections. Vancomycin is a bactericidal antibiotic that acts by inhibiting bacterial cell wall synthesis. This study aimed to compare broth microdilution (BMD) and E-test in determining vancomycin minimum inhibitory concentration (MIC) against MRSA.Methods: A total of 30 clinical isolates of MRSA were acquired from Colombo South Teaching Hospital, Sri Lanka. These MRSA strains were identified by cefoxitin disk diffusion and the vancomycin MIC was determined through BMD and E-test. The Kruskal-Wallis test was applied to test if the samples originated from the same distribution with post hoc determination of the correlation between methods using the Mann-Whitney U test.Results: All 30 MRSA isolates were 100% vancomycin susceptible (≤2 μg/mL) irrespective of methodology, according to the Clinical and Laboratory Standards Institute (CLSI) established breakpoints. However, the E-test MIC values were 1 to 2 dilutions higher than those of BMD. A statistically significant difference between vancomycin MICs of BMD and E-test (p = <0.00001) was calculated which indicated a difference in accuracy.Conclusion: Due to cost, convenience, and the ability to detect vancomycin intermediate Staphylococcus aureus (VISA), exploring the possibility of using E-test as an alternative to BMD is worthwhile.

Identification of small molecule inhibitors of penicillin-binding protein 2a of methicillin-resistant Staphylococcus aureus for the therapeutics of bacterial infection.

The penicillin binding protein 2a (PBP2a) is a key enzyme associated with bacterial cell wall synthesis and bacterial infection. Therefore, targeting PBPa2 offers a promising approach for the therapeutics of bacterial resistance and infection. This study presents a comprehensive analysis of alpha-mangostin as a potential inhibitor of PBPa2. Molecular docking simulations revealed a strong binding affinity between alpha-mangostin and PBP2a, with an affinity score of -6.01 kcal/mol. Notably, alpha-mangostin formed a preferential hydrogen bond with THR216 of PBP2a, alongside several other polar and hydrophobic interactions. ADME and Toxicity predictions indicated that alpha-mangostin possesses favourable pharmacokinetic properties, suggesting its potential as a therapeutic agent. PASS analysis further highlighted its broad range of favourable biological properties. SwissTargetPrediction analysis reinforced these findings, indicating alpha-mangostin's association with various biological processes. Cell toxicity assays demonstrated that alpha-mangostin had no significant impact on the viability of HEK-293 cells, suggesting its potential safety for further development. The IC50 value for alpha-mangostin was found to be 33.43µM. Fluorescence-based binding assays showed that alpha-mangostin effectively inhibited PBP2a activity in a concentration-dependent manner, supporting its role as an inhibitor. In conclusion, the results suggest alpha-mangostin as a promising candidate for inhibiting PBP2a. Further, extensive studies are warranted to explore its clinical applications.

Chitosan‐Stabilized PtAu Nanoparticles with Multienzyme‐Like Activity for Mixed Bacteria Infection Wound Healing and Insights into Its Antibacterial Mechanism

Traditional antibacterial agents are often observed to be ineffective because bacteria evolved to strains with greater antibiotic resistance. Here, vigorous chitosan‐stabilized PtAu nanoparticles (CSPA) with multienzyme‐like activity are successfully fabricated, which serve an effective artificial nanozyme to enhance antibacterial activity for mixed bacterial infection wound treatment. Ultrasmall size CSPA exhibits excellent hydrophilicity and biocompatibility, possesses strong oxidase‐ and peroxidase‐like activity generating a substantial amount of ROS (, 1O2, ·OH) to cause oxidative damage to bacteria, also demonstrates nicotinamide adenine dinucleotide dehydrogenase‐like activity disrupting the bacterial respiratory chains, and subsequently impedes adenosine triphosphate production. CSPA exhibits favorable broad‐spectrum antibacterial activity at very low concentrations, prevents bacterial resistance, and completely inhibits bacterial biofilm formation. Antibacterial Mechanism of CSPA by the transcriptomics is further revealed that CSPA can induce bacterial oxidative stress, hinder bacterial energy metabolism, and disrupt the synthesis and function of bacterial cell walls and cell membranes. In vivo, CSPA inhibits the mixed bacterial population at the wound site and promotes wound healing in rats. This study introduces a novel antibacterial approach, providing important insight into the antibacterial mechanism of CSPA nanozymes and promoting the advancement of nanocatalytic materials in biomedical applications.

Reciprocal regulation of enterococcal cephalosporin resistance by products of the autoregulated yvcJ-glmR-yvcL operon enhances fitness during cephalosporin exposure.

Enterococci are commensal members of the gastrointestinal tract and also major nosocomial pathogens. They possess both intrinsic and acquired resistance to many antibiotics, including intrinsic resistance to cephalosporins that target bacterial cell wall synthesis. These antimicrobial resistance traits make enterococcal infections challenging to treat. Moreover, prior therapy with antibiotics, including broad-spectrum cephalosporins, promotes enterococcal proliferation in the gut, resulting in dissemination to other sites of the body and subsequent infection. As a result, a better understanding of mechanisms of cephalosporin resistance is needed to enable development of new therapies to treat or prevent enterococcal infections. We previously reported that flow of metabolites through the peptidoglycan biosynthesis pathway is one determinant of enterococcal cephalosporin resistance. One factor that has been implicated in regulating flow of metabolites into cell wall biosynthesis pathways of other Gram-positive bacteria is GlmR. In enterococci, GlmR is encoded as the middle gene of a predicted 3-gene operon along with YvcJ and YvcL, whose functions are poorly understood. Here we use genetics and biochemistry to investigate the function of the enterococcal yvcJ-glmR-yvcL gene cluster. Our results reveal that YvcL is a DNA-binding protein that regulates expression of the yvcJ-glmR-yvcL operon in response to cell wall stress. YvcJ and GlmR bind UDP-GlcNAc and reciprocally regulate cephalosporin resistance in E. faecalis, and binding of UDP-GlcNAc by YvcJ appears essential for its activity. Reciprocal regulation by YvcJ/GlmR is essential for fitness during exposure to cephalosporin stress. Additionally, our results indicate that enterococcal GlmR likely acts by a different mechanism than the previously studied GlmR of Bacillus subtilis, suggesting that the YvcJ/GlmR regulatory module has evolved unique targets in different species of bacteria.

Optimizations of lipid II synthesis: an essential glycolipid precursor in bacterial cell wall synthesis and a validated antibiotic target.

Lipid II is an essential glycolipid found in bacteria. Accessing this valuable cell wall precursor is important both for studying cell wall synthesis and for studying/identifying novel antimicrobial compounds. Herein, we describe optimizations to the modular chemical synthesis of lipid II and unnatural analogues. In particular, the glycosylation step, a critical step in the formation of the central disaccharide unit (GlcNAc-MurNAc), was optimized. This was achieved by employing the use of glycosyl donors with diverse leaving groups. The key advantage of this approach lies in its adaptability, allowing for the generation of a wide array of analogues through the incorporation of alternative building blocks at different stages of synthesis.

Ultrastructural and morphological studies on variables affecting Escherichia coli with selected commercial antibiotics

BackgroundMany studies reported the effects of antibiotic exposure on E. coli bacterial growth and cell modification. However, scarce descriptive information on ultrastructural effects upon exposure of commercial antibiotics. MethodsThis study described the morphological and ultrastructural alterations caused by selected antibiotics (amoxicillin-clavulanate, ceftriaxone, polymyxin B, colistin, gentamicin, and amikacin) that targeted cell wall, plasma membrane, and cytoplasmic density, and also proteins synthesis. We determined extracellular morphological changes of exposure through scanning electron microscopy (FESEM) and intracellular activities through transmission electron microscopy (TEM) investigation. ResultsFESEM and TEM micrograph of E. coli exposed with selected antibiotics shows ultrastructural changes in beta-lactam class (amoxicillin-clavulanate, ceftriaxone) elongated the cells as the cell wall was altered as it inhibits bacterial cell wall synthesis, polymyxin class (polymyxin B, colistin) had plasmid and curli-fimbriae as it breaking down the plasma/cytoplasmic membrane, and aminoglycoside class (gentamicin, and amikacin) reduced ribosome concentration as it inhibits bacterial protein synthesis by binding to 30 s ribosomes. ConclusionMorphological and ultrastructural alterations of E. coli’s mechanism of actions were translated and depicted. This study could be reference for characterization studies for morphological and ultrastructural of E. coli upon exposure to antimicrobial agents.

A Review on the Use of Third-Generation Cephalosporins on Gram-Positive and Gram-Negative Bacteria Based on its Spectrum of Activity

This review explores the clinical usage of third-generation cephalosporins, a class of broad-spectrum antibiotics that are essential for treating gram-positive and gram-negative bacterial infections in a variety of infectious conditions. These antibiotics have bactericidal action by inhibiting the synthesis of bacterial cell walls. Among the well-known members of this class are cefoperazone, cefpodoxime proxetil, ceftibuten, ceftriaxone, cefotaxime, and ceftazidime. Inhibiting transpeptidase is the mechanism of action, which, in the case of gram-negative bacteria, results in cell lysis and death. Third-generation cephalosporins are used to treat a wide range of conditions, including meningitis, genitourinary tract infections, pneumonia, infections of the skin and soft tissues, and bone and joint infections. Each cephalosporin within this generation exhibits a distinct spectrum of activity. For instance, cefpodoxime proxetil acts against Staphylococcus aureus and Klebsiella pneumoniae, whereas cefixime acts against Streptococcus pneumoniae and Escherichia coli. Neisseria gonorrhoea and Pseudomonas aeruginosa are only two examples of the many gram-positive and gram-negative bacteria that ceftriaxone is active against. This review also highlights the synergistic effects of combining third-generation cephalosporins with other antibiotics, demonstrating their versatility in managing complex infections. Despite their effectiveness, third-generation cephalosporins may not be effective against Chlamydia trachomatis. Furthermore, careful consideration of each antibiotic's spectrum guides their specific use in treating conditions such as urinary tract infections, otitis media, bronchitis, and gynecologic infections. In conclusion, the comprehensive spectrum of action of third-generation cephalosporins makes them valuable in addressing a diverse array of bacterial infections. However, their use should be judicious, considering the evolving landscape of antibiotic resistance and the specific bacterial targets for optimal therapeutic outcomes.

Propene-bridged cyanurate tetramers decorated on carbon nanosheets with antibacterial activity: insights from molecular modeling and in vitro studies

Propene-bridged cyanurate tetramers (PBCTs) nested onto 2D nanosheets (CNHs) exhibit antibacterial activity by disrupting bacterial cell wall synthesis.

Metabolomics reveals the mechanism of action of meropenem and amikacin combined in the treatment of Pseudomonas aeruginosa.

The treatment of Pseudomonas aeruginosa infection often involves the combined use of β-lactam and aminoglycoside antibiotics. In this study, we employed metabolomic analysis to investigate the mechanism responsible for the synergistic activities of meropenem/amikacin combination therapy against multidrug-resistant P. aeruginosa strains harboring OXA-50 and PAO genes. Antibiotic concentrations for meropenem (2 mg/L) monotherapy, amikacin (16 mg/L) monotherapy, and meropenem/amikacin (2/16 mg/L) combination therapy were selected based on clinical breakpoint considerations. Metabolomic analysis revealed significant alterations in relevant metabolites involved in bacterial cell membrane and cell wall synthesis within 15 min of combined drug administration. These alterations encompassed various metabolic pathways, including fatty acid metabolism, peptidoglycan synthesis, and lipopolysaccharide metabolism. Furthermore, at 1 h and 4 h, the combination therapy exhibited significant interference with amino acid metabolism, nucleotide metabolism, and central carbon metabolism pathways, including the tricarboxylic acid cycle and pentose phosphate pathway. In contrast, the substances affected by single drug administration at 1 h and 4 h demonstrated a noticeable reduction. Meropenem/amikacin combination resulted in notable perturbations of metabolic pathways essential for survival of P. aeruginosa, whereas monotherapies had comparatively diminished impacts.

Antibacterial and biofilm prevention metabolites from Acanthophora spicifera

Abstract Acanthophora spicifera harbors a diverse array of secondary metabolites with therapeutic potential. The aim of this study is to isolate and characterize secondary metabolites from A. spicifera and then evaluate the antiproliferation, antibacterial, and biofilm prevention properties, followed by an analysis of molecular docking experiments. By employing chromatographic analysis and NMR spectroscopy, the isolated compounds were, the known flavonol, 8-hydroxyquercetagetin (1), three recognized steroids cholest-4-ene-3,6-dione (2), cholest-5-en-3β-ol (3), and 5α-cholestane-3,6-dione (4), and 2-bromohexadecanoic acid (5). These compounds exhibited antimicrobial effects against various Gram-negative and Gram-positive bacteria with inhibition zones ranging from 6.5 ± 0.2 to 17.2 ± 0.12 mm and 7.0 ± 0.4 to 15.3 ± 0.60 mm, respectively. Compounds 1 and 2 inhibited biofilm formation in P. aeruginosa and S. aureus. Compounds 1–4 demonstrated binding affinity values between −7.5 and −9.4 kcal/mol to protein 1A0G. These binding affinity values were akin to that of amoxicillin, implying that one potential antibacterial mechanism of action of these compounds may involve the inhibition of bacterial cell wall synthesis. All compounds showed no toxicity against Artemia salina and weak activity against Lymphoma and Lewis lung carcinoma cell lines with LD50 > 100 μg/mL.

Bacitracin enhances ceftriaxone susceptibility of the high-level ceftriaxone-resistant gonococcal FC428 clone

ABSTRACT Neisseria gonorrhoeae is a multidrug-resistant bacterial pathogen for which ceftriaxone mono-antimicrobial therapy and ceftriaxone plus azithromycin dual-antimicrobial therapy are the only remaining effective therapies. However, ceftriaxone efficacy is threatened by the global dissemination of the high-level ceftriaxone-resistant FC428 clone, while azithromycin has in recent years been removed from the recommended dual therapy in some countries as a result of increasing (high-level) azithromycin resistance. Inclusion of an alternative second antimicrobial could be an effective strategy to protect ceftriaxone from (further) resistance development. In this study, we investigated gonococcal susceptibility to bacitracin and determined its synergistic anti-gonococcal activity with ceftriaxone. Gonococcal susceptibility to bacitracin was investigated for 449 contemporary clinical isolates using the agar dilution method. Bacitracin displayed consistent activity against the N. gonorrhoeae strain collection, with a minimum inhibitory concentration (MIC) range of 2–32 mg/L and a MIC 90 of 32 mg/L. Furthermore, bacitracin was bactericidal in time-kill assays, particularly against the tested FC428-associated isolate, which showed 10 5 -fold inactivation after 8 hours of exposure to a 4× MIC dose. Importantly, bacitracin and ceftriaxone displayed synergistic activity, with a fractional inhibitory concentration index ≤0.5 for the majority of tested strains. Finally, spot assays showed strong synergistic activity against the FC428-associated isolates, with up to 200-fold reduced plating efficacy for bacitracin combined with ceftriaxone compared with ceftriaxone only. In conclusion, bacitracin shows synergistic anti-gonococcal activity with ceftriaxone and might therefore be an interesting candidate for inclusion in a dual-antimicrobial therapy with ceftriaxone. IMPORTANCE Ceftriaxone-based antimicrobial therapies for gonorrhea are threatened by waning ceftriaxone susceptibility levels and the global dissemination of the high-level ceftriaxone-resistant gonococcal FC428 clone. Combination therapy can be an effective strategy to restrain the development of ceftriaxone resistance, and for that purpose, it is important to find an alternative antimicrobial to replace azithromycin, which has recently been removed in some countries from the recommended ceftriaxone plus azithromycin dual-antimicrobial therapy. Ideally, the second antimicrobial should display synergistic activity with ceftriaxone. We hypothesized that bacitracin might display synergistic activity with ceftriaxone because of their distinct mechanisms targeting bacterial cell wall synthesis. In this study, we showed that bacitracin indeed displays synergistic activity with ceftriaxone against Neisseria gonorrhoeae . Importantly, strains associated with the FC428 clone appeared to be particularly susceptible to the bacitracin plus ceftriaxone combination, which might therefore be an interesting dual therapy for further in vivo testing.