High Stability and Low Irritation of Enrofloxacin-Colistin Combination Injection Through a Tripartite Strategy.

Introduction: The rapid progression of bacterial resistance and the dearth of novel antimicrobial drug development impose a significant public health burden on the treatment of bacterial infections. Drug combination therapy has become an attractive strategy for combating multidrug-resistant bacterial infections. More importantly, matching the physicochemical properties of multiple components in formulations is essential for clinical application.

Methods: First, an enrofloxacin-colistin combination injection was developed using a tripartite strategy, defined as a three-step process involving the conversion of enrofloxacin to its salt form, the addition of 1,2-propanediol, and pH adjustment. Second, independent gradient model based on Hirshfeld surface (IGMH), nuclear magnetic resonance (NMR), and ultraviolet-visible spectroscopy (UV-vis) analysis were used to investigate the molecular mechanism of this process. Finally, the irritancy, toxicity, and efficacy of the combination injection were evaluated in vivo and in vitro.

Results: The tripartite strategy increased the solubility of enrofloxacin by 1500-fold from 0.18 mg/mL to 272.76 mg/mL, thereby preventing enrofloxacin precipitation during 6 months at both 30°C and 4°C, maintaining colistin stability, and reducing injection-site irritation. 1,2-Propanediol enhanced hydrogen bonding with enrofloxacin and inhibited its self-aggregation. Importantly, the combination injection exhibited no significant liver and kidney toxicity while demonstrating outstanding therapeutic efficacy against Pasteurella multocida pneumonia with 62.5% survival rate.

Discussion: The limited solubility of enrofloxacin has long hindered its co-formulation with pH-sensitive drugs. The tripartite strategy establishes a paradigm for overcoming challenges related to the crystal precipitation of insoluble drugs and the pH limitations in complex formulations. Our findings demonstrate that the tripartite strategy effectively enhances the solubility, stability, and therapeutic efficacy of enrofloxacin-colistin combinations, offering a novel solution to overcome challenges in developing complex antibacterial formulations for veterinary use.