Therapy with antimicrobial drugs, such as clindamycin, that perturb the intestinal flora but fail to inhibit growth of other microorganisms can permit the proliferation of Clostridium difficile and the elaboration of exotoxin. Therefore, there has been increasing interest in the use of inhibitors of antibiotic resistance for use in combination therapy. The essential oil of Cinnamomum zeylanicum bark enhanced the bactericidal activity of clindamycin and decreased the minimum inhibitory concentration of clindamycin required for a toxicogenic strain of C. difficile. Thin-layer chromatography (TLC) analysis of the essential oil separated a fraction (R(f) = 0.54) that was the most effective at enhancing the clindamycin antimicrobial activity. Using gas liquid chromatography and known standards, the active fraction was identified as trans-cinnamaldehyde (3-phenyl-2-Propenal). Combinations of clindamycin and trans-cinnamaldehyde were tested to determine the fractional inhibitory concentration (FIC) index by conventional checkerboard titration. The FIC index for C. difficile was found to be 0.312, which confirmed the synergistic actions of clindamycin and trans-cinnamaldehyde. The presence of 20 microg/mL of trans-cinnamaldehyde decreased the MIC of clindamycin for C. difficile 16-fold, from 4.0 to 0.25 microg/mL. These results signify that low concentrations of trans-cinnamaldehyde elevate the antimicrobial action of clindamycin, suggesting a possible clinical benefit for utilizing these natural products for combination therapy against C. difficile.
Methicillin-Resistant Staphylococcus aureus (MRSA) biofilms are involved in various nosocomial infections, being in the limelight of academic research. The current study aimed to determine the antimicrobial effects of melittin on planktonic and biofilm forms of S. aureus . Following the identification of MRSA and SCCmec types (using PCR method), Minimum Inhibitory Concentration (MIC), Minimum Bactericidal Concentration (MBC), and fractional inhibitory concentration index (FICi), for melittin and mupirocin were determined by broth microdilution assay. Melittin anti-biofilm activity was determined, using a microtiter-plate test (MtP) and scanning electron microscope (SEM) methods. The quorum sensing inhibitory activity of ½ MIC melittin was examined using a quantitative real-time RT-PCR method, and melittin cytotoxicity on Vero cells was examined by tetrazolium-based colorimetric (MTT) test. The Results of our study showed that Geometric means of MIC values of the melittin and mupirocin were 4.4 and 14.22 μg/ml respectively. The geometric mean of the FICi for both melittin-mupirocin was 0.75. No S. aureus biofilm was formed and hld gene (as a biofilm regulator) expression down-regulated. It seems that melittin can be useful in the treatment of S. aureus infections (especially MRSA) by reducing the hld expression. Furthermore, synergistic growth-inhibitory effects of mupirocin with melittin could be considered as a promising approach in the treatment of MRSA isolates.
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