In vitro synergistic effect of sumac in combination with cloxacillin, cephalexin, and vancomycin against clinical isolates of methicillin-resistant staphylococcus aureus MRSA Inhibition: Sumac and Antibiotic Combinations
Iranian Journal of Pharmaceutical Sciences,
Vol. 21 No. 1 (2025),
21 January 2025
,
Page 208-216
https://doi.org/10.22037/ijps.v21i1.46625
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has been associated with substantially higher morbidity and mortality rates due to the acquired multidrug resistance. Accordingly, there exists a growing demand for development of natural products as alternative treatments or combination drug therapies against this infection. This study aimed to assess the synergistic effect of sumac in combination with clinically important antibiotics against ten clinical isolates of MRSA. A total of 50 staphylococci clinical isolates were screened for susceptibility to antibiotics, and 10 isolates were selected for further studies. The disc diffusion method (DDM) was used to screen the synergy effects of the sumac extract with 7 antibiotics against clinical isolates of MRSA. The broth microdilution method determined the minimum inhibitory concentration (MICs) of sumac extract and three selected antibiotics. The synergistic effect of the sumac extract and three antibiotics was assessed and evaluated using checkerboard dilution methods. The three antibiotics, i.e., cloxacillin, cephalexin, and vancomycin, showed considerable synergistic effects with sumac extract based on DDM. The MICs of sumac against ten clinical MRSA isolates ranged from 1600 to 6400 µg/ml. In the checkerboard dilution method, sumac markedly reduced the MICs of the antibiotics cloxacillin and cephalexin, and a significant synergistic effect was recorded by sumac in combination with these two antibiotics. Our results demonstrated that sumac extract enhances the antibiotic potential against MRSA in vitro conditions. This study suggested that sumac, in combination with antibiotics, could lead to the development a new combination of antibiotics against MRSA.
- Rhus coriaria L.
- Sumac
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Minimum inhibitory concentration (MIC)
- Synergistic effects
How to Cite
References
Nimer NA. Nosocomial Infection and Antibiotic-Resistant Threat in the Middle East. Infect. Drug Resist. (2022) 15: 631-639.
Lacey KA, Geoghegan JA, McLoughlin RM. The role of Staphylococcus aureus virulence factors in skin infection and their potential as vaccine antigens. Pathogens. (2016) 5 (1): 22.
Kitur K et al. Necroptosis promotes Staphylococcus aureus clearance by inhibiting excessive inflammatory signaling. Cell Reports (2016) 16 (8): 2219-2230.
Bouiller K, Gbaguidi-Haore H, Hocquet D, Cholley P, Bertrand X, Chirouze C. Clonal complex 398 methicillin-susceptible Staphylococcus aureus bloodstream infections are associated with high mortality. Clin. Microbiol. Infect. (2016) 22 (5): 451-5.
DeLeo FR, Otto M, Kreiswirth BN, Chambers HF. Community-associated meticillin-resistant Staphylococcus aureus. Lancet. (2010) 375 (9725): 1557-1568.
Dadashi M. et al. Methicillin-resistant Staphylococcus aureus (MRSA) in Iran: A systematic review and meta-analysis. J. Glob. Antimicrob. Resist. (2017) 12: 96-103.
Fishovitz J, Taghizadeh N, Fisher JF, Chang M, Mobashery S. The Tipper–Strominger hypothesis and triggering of allostery in penicillin-binding protein 2a of methicillin-resistant Staphylococcus aureus (MRSA). J. Am. Chem. Soc. (2015) 137 (20): 6500-6505.
Davis JS, Van Hal S, Tong SY. Combination antibiotic treatment of serious methicillin-resistant Staphylococcus aureus infections. Seminars in respiratory and critical care medicine. Semin. Respir. Crit. Care. Med. (2015) 36 (1): 3-16.
Tängdén T. Combination antibiotic therapy for multidrug-resistant Gram-negative bacteria. Upsala J. Med. Sci. (2014) 119 (2): 149-53.
Yuan H, Ma Q, Ye L, Piao G. The traditional medicine and modern medicine from natural products. Molecules. (2016) 21 (5): 559.
Cheesman MJ, Ilanko A, Blonk B, Cock IE. Developing new antimicrobial therapies: Are synergistic combinations of plant extracts/compounds with conventional antibiotics the solution? Pharmacogn. Rev. (2017) 11 (22): 57-72.
Bashash M, Bolandi M, Zamindar N. Phenolic Content of Selected Sumac Fruits from Iran, Extracted With Different Solvents. J. Chem. Health Risks. (2012) 2 (4): 17-20.
Rayne S, Mazza G. Biological activities of extracts from sumac (Rhus spp.): a review. Plant Foods Hum. Nutr. (2007) 62 (4): 165-75.
Ahmadian-Attari MM, Amin Gh, Fazeli MR, Jamalifar H. A review on antimicrobial activities of sumac fruit (Rhus coriaria L.). J. Med. Plants. (2008) 7 (25): 1-11.
Fazeli MR, Ashtiani H, Ahmadian-Attari MM, Jamalifar H, Zaheri A. Antimicrobial effect of Rhus coriaria L. (sumac) total extract on skin isolates Staphylococcus epidermidis and Corynebacterium xerosis. J. Med. Plants. (2006) 5 (17): 27-31.
Fazeli MR, Amin Gh, Ahmadian-Attari MM, Ashtiani H, Jamalifar H, Samadi N. Antimicrobial activities of Iranian sumac and avishan-e shirazi (Zataria multiflora) against some food-borne bacteria. Food Control. (2007) 18 (6): 646-649.
Ferk F, Chakraborty A, Simic T, Kundi M, Knasmüller S. Antioxidant and free radical scavenging activities of sumac (Rhus coriaria) and identification of gallic acid as its active principle. BMC Pharmacol. (2007) 7 (Suppl 2): A71.
Timurkaynak F, Can F, Azap ÖK, Demirbilek M, Arslan H, Karaman SÖ. In vitro activities of non-traditional antimicrobials alone or in combination against multidrug-resistant strains of Pseudomonas aeruginosa and Acinetobacter baumannii isolated from intensive care units. Int. J. Antimicrob. Agents. (2006) 27 (3): 224-8.
van Duin D, Paterson DL. Multidrug-resistant bacteria in the community: trends and lessons learned. Infect Dis Clin North Am. (2016) 30 (2): 377-90.
Hawkey PM, et al. Treatment of infections caused by multidrug-resistant Gram-negative bacteria: report of the British Society for Antimicrobial Chemotherapy/healthcare Infection Society/british Infection Association Joint Working Party. J. Antimicrob. Chemother. (2018) 73 (suppl_3): iii2-iii78.
Sakagami Y, Iinuma M, Piyasena K, Dharmaratne H. Antibacterial activity of α-mangostin against vancomycin resistant Enterococci (VRE) and synergism with antibiotics. Phytomed. (2005) 12 (3): 203-8.
Phitaktim S, Chomnawang M, Sirichaiwetchakoon K, Dunkhunthod B, Hobbs G, Eumkeb G. Synergism and the mechanism of action of the combination of α-mangostin isolated from Garcinia mangostana L. and oxacillin against an oxacillin-resistant Staphylococcus saprophyticus. BMC Microbiol. (2016) 16 (1): 195.
Ahmadian-Attari MM, Amini M, Farsam H, Amin Gh, Fazeli MR, Monsef Esfahani HR, Jamalifar H, Bairami A. Isolation of Major Active Antibacterial Compounds of Sumac Fruit (Rhus coriaria L.). Int. J. Enteric. Pathog. (2016) 4 (4): 1-5.
Siriwong S, Teethaisong Y, Thumanu K, Dunkhunthod B, Eumkeb G. The synergy and mode of action of quercetin plus amoxicillin against amoxicillin-resistant Staphylococcus epidermidis. BMC Pharmacol. Toxicol. (2016) 17 (1): 39.
Asokkumar K, Sen S, Umamaheswari M, Sivashanmugam A, Subhadradevi V. Synergistic effect of the combination of gallic acid and famotidine in protection of rat gastric mucosa. Pharmacol. Rep. (2014) 66 (4): 594-9.
Borges A, Ferreira C, Saavedra MJ, Simoes M. Antibacterial activity and mode of action of ferulic and gallic acids against pathogenic bacteria. Microb. Drug Resist. (2013) 19 (4): 256-65.
Shibata H, et al. Triple combinations of lower and longer alkyl gallates and oxacillin improve antibiotic synergy against methicillin-resistant Staphylococcus aureus. Antimicrob. Agents Chemother. (2009) 53 (5): 2218-20.
Cho H, Uehara T, Bernhardt TG. Beta-lactam antibiotics induce a lethal malfunctioning of the bacterial cell wall synthesis machinery. Cell. (2014) 159 (6): 1300-1311.
El-Kalek HHA, Mohamed EA. Synergistic effect of certain medicinal plants and amoxicillin against some clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA). Int. J. Pharm. Appl. (2012) 3 (3): 387-398.
Rybak MJ, et al. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin. Infect. Dis. (2009) 49 (3): 325-327.
Hemaiswarya S, Kruthiventi AK, Doble M. Synergism between natural products and antibiotics against infectious diseases. Phytomed. (2008) 15 (8): 639-52.
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