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Its ability to form biofilms, regulated in part by quorum sensing, contributes to its persistence and resistance. Classified as a critical priority pathogen by the World Health Organization, there is an urgent need for new therapeutic strategies. In this study, we evaluated the effects of quercetin, baicalein and azithromycin, alone and in combination, on biofilm formation, virulence factor production, and quorum sensing gene expression in\n                      <jats:italic>P. aeruginosa<\/jats:italic>\n                      PAO1.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>\n                      The minimum inhibitory concentration of each compound was measured. The effect of each compound and their combinations on biofilm formation, elastases, pyocyanin and rhamnolipids were evaluated by spectrophotometric assays, and on\n                      <jats:italic>lasR<\/jats:italic>\n                      and\n                      <jats:italic>mvfR<\/jats:italic>\n                      gene expression by RT-qPCR. The minimum inhibitory concentrations of quercetin, baicalein and azithromycin were &gt;\u2009250, 62, and 16\u00a0\u00b5g\/mL, respectively. The individual compound with the lowest percentage of biofilm formation was quercetin, followed by azithromycin and baicalein with 33%, 48%, and 51%, and the best combination was azithromycin-baicalein with 35%. Azithromycin and the mentioned combination showed the lowest production of elastases, pyocyanin and rhamnolipids (39% and 34%; 8% and 13%; 19% and 16%, respectively) and resulted in\n                      <jats:italic>lasR<\/jats:italic>\n                      and\n                      <jats:italic>mvfR<\/jats:italic>\n                      gene expression levels of 32% and 34%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The combination of azithromycin-baicalein showed inhibitory effects on biofilm formation, virulence factors and gene expression of\n                      <jats:italic>lasR<\/jats:italic>\n                      and\n                      <jats:italic>mvfR<\/jats:italic>\n                      . These findings highlight the potential of combining natural products with antibiotics as a promising strategy to attenuate virulence and disrupt quorum sensing-regulated behaviors in\n                      <jats:italic>P. aeruginosa<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11033-026-11876-x","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T12:17:43Z","timestamp":1779452263000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Effects of quercetin, baicalein, azithromycin, and their combination on biofilm formation, virulence factors and gene expression associated with Pseudomonas aeruginosa quorum sensing"],"prefix":"10.1007","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7391-8320","authenticated-orcid":false,"given":"Valentina","family":"Parra Rodr\u00edguez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7992-5430","authenticated-orcid":false,"given":"Vanessa","family":"G\u00f3mez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8723-0436","authenticated-orcid":false,"given":"Ludy Cristina","family":"Pab\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1730-9648","authenticated-orcid":false,"given":"Patricia","family":"Hern\u00e1ndez-Rodr\u00edguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"issue":"11","key":"11876_CR1","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.1017\/ice.2016.174","volume":"37","author":"LM Weiner","year":"2016","unstructured":"Weiner LM, Webb AK, Limbago B et al Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011\u20132014. infection control & hospital epidemiology. 2016 Nov;37(11):1288-301. https:\/\/doi.org\/10.1017\/ice.2016.174","journal-title":"Infect control Hosp Epidemiol"},{"issue":"6","key":"11876_CR2","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1128\/AAC.02671-16","volume":"61","author":"JT Thaden","year":"2017","unstructured":"Thaden JT, Park LP, Maskarinec SA et al (2017) Results from a 13-year prospective cohort study show increased mortality associated with bloodstream infections caused by Pseudomonas aeruginosa compared to other bacteria. 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