41Abstract In Gram positive bacteria, bNOS-derived NO confers the protection of
bacteria from environmental stress such as antibiotic challenges. ART can exert an
antibiotic sensitizing role through inhibiting bNOS and CAT. Either in vivo or in
vitro, ART can increase the bacteriocidal activity of antibiotics by abrogating the
beneficial NO and enhancing the harmful H 2 O 2 , demonstrating a potential role in
combating multidrug resistant bacteria.
Keywords ART · Bacteria · bNOS · H 2 O 2 · Multidrug resistance · NO
4.1 An Overview on Bacterial Infection
and Antibacterial Infection
Tuberculosis is a kind of leading lethal infectious disease due to infection by
M. tuberculosis. Currently, the first-line drugs used for treating patients with tuber-
culosis are conventional drugs invented several decades ago, and the second-line
drugs are often expensive but less effective. Following the abuse and irregular
use of antibiotics, M. tuberculosis has evolved to exhibit the multidrug resistance
(MDR) and extensive drug resistance (EDR). Patients with the MDR-type tubercu-
losis would fail to respond to a standard therapeutic cohort, and the needed antibi-
otic dosages should increase for more than 1000 folds. The EDR-type tuberculosis
exhibits antibiotic resistance similar with the MDR-type tuberculosis, but toler-
ance to fluoroquinolones and one of three kinds of second-line drugs (Raviglione
2007 ). Upon the endemic occurrence of MDR and EDR M. tuberculosis strains,
development of novel antituberculosis drugs becomes urgently needed.
Apart from M. tuberculosis, the most popular MDR bacteria (so-called “super
bugs”) is methicillin-resistant Staphylococcus aureus (MRSA) with the plasmid-
carrying methicillin-resistant gene bla (^) CTX-M-15 (Walsh et al. 2007 ; Hawkey 2008 ),
where bla encodes beta-lactamase, belonging to the group of extended spectrum
beta-lactamase (ESBL). MRSA strains first occurred in 1960, and were prevalent
Chapter 4
ART for Antibacterial Infection
© The Author(s) 2015
Q.-P. Zeng, Artemisinin and Nitric Oxide, SpringerBriefs in Molecular Science,
DOI 10.1007/978-3-662-47688-8_4