RESEARCH ARTICLE An adjunctive therapy administered with an antibiotic prevents enrichment of antibiotic-resistant clones of a colonizing opportunistic pathogen Valerie J Morley1*, Clare L Kinnear2, Derek G Sim1, Samantha N Olson1, Lindsey M Jackson1, Elsa Hansen1, Grace A Usher3, Scott A Showalter3,4, Manjunath P Pai5, Robert J Woods2, Andrew F Read1,6,7 1Center for Infectious Disease Dynamics, Department of Biology, The Pennsylvania State University, University Park, United States; 2Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, United States; 3Department of Biochemistry and Molecular Biology, The Pennsylvania State University, University Park, United States; 4Department of Chemistry, The Pennsylvania State University, University Park, United States; 5Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, United States; 6Huck Institutes for the Life Sciences, The Pennsylvania State University, University Park, United States; 7Department of Entomology, The Pennsylvania State University, University Park, United States Abstract A key challenge in antibiotic stewardship is figuring out how to use antibiotics therapeutically without promoting the evolution of antibiotic resistance. Here, we demonstrate proof of concept for an adjunctive therapy that allows intravenous antibiotic treatment without driving the evolution and onward transmission of resistance. We repurposed the FDA-approved bile acid sequestrant cholestyramine, which we show binds the antibiotic daptomycin, as an ‘anti- *For correspondence: antibiotic’ to disable systemically-administered daptomycin reaching the gut. We hypothesized that
[email protected] adjunctive cholestyramine could enable therapeutic daptomycin treatment in the bloodstream, Competing interests: The while preventing transmissible resistance emergence in opportunistic pathogens colonizing the authors declare that no gastrointestinal tract.