title: Synergy between antibiotics and natural agents results in increased antimicrobial activity against Staphylococcus epidermidis.
abstract: BACKGROUND
  Staphylococcus epidermidis is one of the most frequent causes of biofilm-associated infections on indwelling medical devices. With the emergence of methicillin-resistant S. epidermidis (MRSE), there is an urgent need to discover novel active agents against a range of Gram-positive pathogens. We screened the clinical isolates of S. epidermidis for susceptibility/resistance against commonly prescribed antibiotics. Furthermore, we tested some natural agents alone and in combination with antibiotics to find possible synergistic antimicrobial effects.
  
  
  METHODS
  S. epidermidis clinical isolates were screened for susceptibility/resistance against vancomycin, erythromycin, tetracycline, chloramphenicol, ampicillin, ofloxacin, cephalexin, and gentamicin using the Kirby-Bauer disk diffusion method. The antimicrobial potential of Camellia sinensis, Juglans regia, and Hippophae rhamnoides alone and in combination with antibiotics were examined using the disk diffusion method, where the antimicrobial potential activity was measured in terms of formation of zones of inhibition.
  
  
  RESULTS
  Most S. epidermidis isolates were found to be resistant to one or more antibiotics. Gentamycin and ofloxacin were found to be the most effective antibiotics against S. epidermidis isolates. Extracts of Hippophae rhamnoides, Juglans regia, and Camellia sinensis were found to be equally effective against S. epidermidis isolates. In combination with antibiotics, these extracts exhibited appreciable synergistic activity; the highest synergistic activity was observed with erythromycin and cephalexin. In the case of cephalexin, a reversion in resistance was observed.
  
  
  CONCLUSIONS
  The plant extracts used in the study exhibited additive and synergistic antibacterial activity against S. epidermidis, hence providing an effective alternative to deal with the problem of multidrug resistance.
authors.affiliation: Aga Khan University, Karachi, Pakistan. m.haniabidi@gmail.com.
authors.forename: Syed Hani
authors.initials: SH
authors.lastname: Abidi
authors.forename: Khalid
authors.initials: K
authors.lastname: Ahmed
authors.forename: Sikander Khan
authors.initials: SK
authors.lastname: Sherwani
authors.forename: Shahana Urooj
authors.initials: SU
authors.lastname: Kazmi
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001688:Biological Products / Q000302:isolation & purification / Q000494:pharmacology*; D028241:Camellia sinensis / Q000737:chemistry; D052978:Disk Diffusion Antimicrobial Tests; D004357:Drug Synergism; D031281:Hippophae / Q000737:chemistry; D006801:Humans; D031324:Juglans / Q000737:chemistry; D010936:Plant Extracts / Q000302:isolation & purification / Q000494:pharmacology*; D013203:Staphylococcal Infections / Q000382:microbiology; D013212:Staphylococcus epidermidis / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D001688:Biological Products; D010936:Plant Extracts