The study tested the natural antimicrobial peptide LL‑37 (along with other peptides) against stubborn mixed fungal‑bacterial biofilms and found it didn’t work at the doses they tried, while synthetic compounds called ceragenins were much better at killing these biofilms.

Multispecies biofilms, in which both fungus and bacteria species can be present, play a significant role in persistent infections, and new therapeutic options are needed against them. In this study, the activities of ceragenins and antimicrobial peptides (AMPs) (magainin, cecropin A, LL-37) were investigated against multispecies biofilms formed by Candida albicans and four clinically important Gram-negative bacteria, including Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae. Our results show that CSA-13 and CSA-90 were the most effective agents against both mono and multispecies biofilms (P < 0.05). CSA-131 and CSA-192 showed the least antimicrobial activity against mono and fungal-bacterial multispecies biofilms. Inhibition of multispecies biofilms with CSA-13 and CSA-90 was also confirmed through fluorescence microscopy images. When AMPs evaluated alone, they proved ineffective against both C. albicans and Gram-negative bacteria at the concentrations tested. In these studies, ceragenins were much more effective than AMPs against multi or monospecies biofilms, especially those containing C. albicans.