Table 2.

Effective mechanism of common antibiotics in the treatment of Pseudomonas infection and mechanism of resistance.

Antibiotic class	Mechanism of action	Mechanism of resistance	Ref.
Aminoglycosides	Inhibition of protein synthesis (through binding to 16srRNA within the 30S ribosomal subunit)	-Aminoglycoside modifying enzymes (AMEs) -Methylation of 16srRNA -Restriction of penetration through binding to the components in the biofilm matrix (eDNA and exopolysaccharides) -Low O2 concentration and metabolism -Efflux pumps	[80,82,87]
Beta-lactams	Inhibition of cell wall peptidoglycan synthesis	-Beta-lactamase present in biofilm matrix (breaking the amide bond of the b-lactam ring) -Low O2 concentration and metabolism -Efflux pumps -Porin downregulation	[80,82,87]
Polymyxin	cell lysis and death through binding to outer membrane lipopolysaccharide (LPS)	-Outer membrane impermeability and modification (Lipid A modification) -Low O2 concentration and metabolism -Efflux pumps (MexAB-OprM and MexCD-OprJ) -Restriction of penetration through binding to the components in the biofilm matrix (eDNA and exopolysaccharides)	[87,88,89,90]
Fluoroquinolones	DNA synthesis blocking (binding to topoisomerases II and IV)	-Low O2 concentration and metabolism -Overexpression of efflux pumps (MexAB-OprM, MexCD-OprJ, and MexEF-OprN) -Chromosomal mutation (In DNA gyrase or topoisomerase encoding genes)	[80,82,87]
Cephalosporins	Inhibition of cell wall synthesis	-Hyper-production of AmpC beta-lactamase. -Overexpression of efflux pumps -Beta-lactamase production -Decrease in porin channel expression	[80,82]