Adjuvant Herbal Therapy Combined with Antibiotics as Methicillin-Resistant Staphylococcus aureus (MRSA) Treatment: A Review

Abstract

Background. Antibiotics used to kill Methicillin-Resistant Staphylococcus aureus (MRSA) are often not effective, even stimulate resistance. To overcome this problem, herbal medicines may help improve antibiotics efficacy. Several herbal medicines have been reported for their unique potential in killing MRSA, either with similar or different mode of actions of the conventional antibiotics. In this case, an adjuvant therapy with herbal medicine is a promising option for the MRSA infections. 

Objectives. This review aims to identify and elaborate the inhibitory mechanisms of anti-MRSA antibiotics and antiMRSA herbal medicines, as well as to evaluate the potential of herbal adjuvant therapies when co-administered with anti-MRSA antibiotics.

Methods. A literature search was conducted using Google Scholar, PubMed, and Science Direct for publications from 2010 to 2024, with keywords 'Mode of Anti-MRSA,' 'Anti-MRSA,' 'herbal medicine,' 'MRSA,' and 'adjuvant therapy.' Eligibility criteria included full open-access Indonesian or English articles with detailed information on anti-MRSA mechanisms, herbal medicine against MRSA, and adjuvant therapy. Articles with only accessible abstracts were excluded. Selection involved title and abstract screening, followed by full-text review based on PICO framework. Data extraction captured essential details on study design, interventions, outcomes, and findings related to MRSA and adjuvant therapies. 

Results. Using the keyword ‘Mode of Anti-MRSA,’ 160 articles were retrieved, with 11 included in the final analysis. Most anti-MRSA antibiotics target the cell wall, inhibit efflux pumps, or act on ribosomes. With the keywords ‘Anti-MRSA’ and ‘herbal medicine,’ 170 articles were retrieved, and nine were included. AntiMRSA herbal materials show strong potential, acting not only on cell wall disruption, efflux pumps, and Penicillinbinding protein 2a (PBP2a) but also inhibiting phosphate kinase (PK), quorum sensing, and biofilm formation. For ‘MRSA’ and ‘adjuvant therapy,’ 210 articles were retrieved, with 20 included. Certain herbal materials in adjuvant therapy have shown promise in enhancing the efficacy of anti-MRSA antibiotics.

Conclusions. When combined with anti-MRSA antibiotic, adjuvant therapy with herbal materials is a promising alternative for treating MRSA infections.