https://orcid.org/0000-0003-3439-9462
Dear editor
We read with great interest the publication entitled “In vitro Antimicrobial Activity and the Mechanism of Berberine Against Methicillin-Resistant Staphylococcus aureus Isolated from Bloodstream Infection Patients”.Citation1
The authors prospectively investigated the antimicrobial activity of berberine and the mechanism by which it combats methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from patients with bloodstream infections.
Berberine (BER) alone, and when combined with clindamycin (CLI) and rifampicin [RIF) separately, displayed excellent antibacterial activity.
Additionally, bacterial cytological profiling indicates that berberine destroyed the structure of the cell walls, biofilm formation, membrane integrity and further changed the cell morphology with increased concentration.
However, we would like to improve the study by adding specific comments. According to recent CLSI guidelines (M100; 2022; Ed32)Citation2 rifampicin should not be used alone for antimicrobial therapy. The authors mentioned the CLSI guidelines in Methodology with reference number “19”; wherein it is a book chapter reference and the author did not give any CLSI guidelines and its references in the bibliography. Furthermore, according to National Treatment Guidelines for Antimicrobial Use in Infectious Diseases-IndiaCitation3, the given guidelines are that rifampicin use should be avoided in diseases other than mycobacterial diseases. Identically it is applicable for all Asian countries where prevalence of tuberculosis is high.
The following criteria have been proposed for initiating rifampicin –
Empiric or proven TB as a part of ATT (4 drug regimen).
Rifampicin should not be prescribed in our country for any treatment other than for mycobacteria. Rifampicin should not be prescribed alone as an antibacterial.
Similarly, the Infectious Diseases Society of America (IDSA) has given guidelines that adding gentamicin or rifampicin to vancomycin is not recommended in patients with bacteraemia or native valve infective endocarditis.Citation4 Data are insufficient to support the routine use of combination therapy with rifampicin or gentamicin in children with bacteraemia or infective endocarditis.
However, we recommend this article and authors for conducting thorough investigations about synergistic effects of BER in combination of CLI and RIF.
Consequently, we hope that future studies will evaluate synergistic effects with combinations of oxacillin, azithromycin, and levofloxacin, whereas an additive effect has been reported for BER in combination with ampicillin, and cefazolin, which might help in abating global antimicrobial resistance to MRSA.
Disclosure
The authors report no conflicts of interest in this communication.
References
- Xia S, Ma L, Wang G, et al. In vitro Antimicrobial Activity and the Mechanism of Berberine Against Methicillin-Resistant Staphylococcus aureus Isolated from Bloodstream Infection Patients. Infect Drug Resist. 2022;15:1933–1944. doi:10.2147/IDR.S357077
- Clinical Laboratory Standard Institute. Performance Standards for Antimicrobial Disk Susceptibility Testing. 32nd ed. Vol. 42. Pennsylvania, USA: CLSI supplement M100; 2022.
- National Treatment Guidelines for Antimicrobial Use in Infectious Diseases. National Centre For Disease Control, Directorate General Of Health Services Ministry Of Health & Family Welfare Government Of India. Version 1.0(2016); 1 - 644. Available from: https://ncdc.gov.in/WriteReadData/l892s/File622.pdf. Accessed May 11, 2022.
- Liu C, Bayer A, Cosgrove SE, et al, Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children, Clinical Infectious Diseases, Volume 52, Issue 3, 1 February 2011, Pages e18–e55, 10.1093/cid/ciq1464. Available from: http://cid.oxfordjournals.org/content/early/2011/01/04/cid.ciq146.full. Accessed May 11, 2022.