Tea tree oil as an alternative topical decolonization agent for methicillin-resistant staphylococcus aureus
Journal of Hospital Infection (2000) 46: 236–237 doi:10.1053/jhin.2000.0830, available online at http://www.idealibrary.com on SHORT REPORT Tea tree oil as an alternative topical decolonization agent for methicillin-resistant Staphylococcus aureus
M. Caelli*, J. Porteous*, C. F. Carson†, R. Heller* and T.V. Riley†
*Department of Clinical Epidemiology, University of Newcastle, Callaghan, NSW 2308 and†Department of Microbiology,The University of Western Australia, Nedlands,WA 6009, AustraliaSummary: The combination of a 4% tea tree oil nasal ointment and 5% tea tree oil body wash was com- pared with a standard 2% mupirocin nasal ointment and triclosan body wash for the eradication of methi- cillin-resistant Staphylococcus aureus carriage. The tea tree oil combination appeared to perform better than the standard combination, although the difference was not statistically significant due to the small number of patients. Keywords: Tea tree oil; mupirocin; MRSA. Introduction
at the John Hunter Hospital, a 624-bed acute referralteaching hospital in Newcastle, NSW, Australia. A
The carriage and subsequent dissemination of methi-
total of 30 adult inpatients, either infected or colo-
cillin-resistant Staphylococcus aureus (MRSA) by
nized with MRSA, was recruited during the nine-
hospital staff and patients is a recognized risk for
month period between December, 1997 and August,
hospital-acquired infections. The emergence of
1998. After informed consent was obtained, partici-
mupirocin-resistant MRSA1 potentially compromises
pants were randomly allocated to receive either 2%
our ability to eradicate the carrier state and alterna-
mupirocin nasal ointment and triclosan body wash
tive agents have been suggested. One such agent is tea
[routine care (RC)] or a 4% tea tree oil nasal oint-
tree oil, an essential oil steam distilled from the leaves
ment and 5% tea tree oil body wash (provided by
of the Australian native plant Melaleuca alternifolia.2
Australian Bodycare Pty Ltd) [intervention care
Tea tree oil is considered an effective topical antimi-
(IC)] for a minimum of three days. Screening for
crobial agent in vitro, with good activity against a
MRSA, from the nares, the perianal region and any
variety of bacteria, including both mupirocin suscep-
site previously positive for MRSA, was undertaken
tible and resistant MRSA.3 However, little clinical
48 and 96 h after the cessation of topical treatment.
Results were analysed on an intention-to-treat basis.
A pilot study to evaluate the clinical efficacy of tea
A summary of outcomes is given in Table I. The
tree oil in the eradication of MRSA was undertaken
number of infected patients in the RC and ICgroups was similar (6/15 vs. 8/15, respectively).
Received 10 November 1999; revised manuscript accepted
The most common site of isolation of MRSA was
skin, accounting for 19 of 30 patients (63%). All
Author for correspondence: Associate Professor ThomasV. Riley, Department of Microbiology, Queen Elizabeth II
infected patients received IV vancomycin in addition
Medical Centre, Nedlands, WA 6009, Australia.
to the decolonization regimen. RC participants
Tea tree oil as a decolonization agent for MRSA
although when examined objectively, screening andcontrol programmes for MRSA are cost-effective.8
Eradication of MRSA colonization can be diffi-
cult, although clearance rates of over 50% with
mupirocin-based regimens have been reported for
both mupirocin-susceptible and low-level resistant
strains of MRSA.9 The appearance of MRSA with
high-level mupirocin resistance has made treatment
of carriage more difficult1 and alternative agents
are urgently needed. In our pilot study, a combina-tion of tea tree oil products performed better thanmupirocin and triclosan, although the number of
were older [average age 74 years (range 45–87)] and
patients was too small for the difference to be sta-
had a shorter average treatment period [5.6 days
tistically significant. Our results do suggest, how-
(range 2–14 days)] than IC participants [58 years
ever, that larger studies are warranted.
(range 32–82)] and [10.7 days (range 1–34 days),respectively]. There was no apparent correlation
between length of treatment and outcome in eithergroup. Two evaluable patients in the IC group were
This study was supported by grants from the
treated for 34 days: one cleared while one remained
Cavell Trust, the Rural Industries Research and
chronically infected. Five bottles of body wash and
Development Corporation and Australian Bodycare
1.8 tubes of nasal ointment per RC participant, and
Pty Ltd. The assistance of staff at the John Hunter
10 bottles of body wash and 1.5 tubes of nasal oint-
Five and seven of the RC and IC groups, respec-
tively, failed to complete treatment for various rea-
1. Cookson BD. The emergence of mupirocin resistance:
sons. Eight of the RC group (53%) and three of the
a challenge to infection control and antibiotic pre-
IC group (20%) remained chronically infected or col-
scribing practice. J Antimicrob Chemother 1998; 41:
onized at the end of treatment. Five of the IC group
2. Carson CF, Riley TV. Antimicrobial activity of the
(33%) were initially cleared of MRSA carriage, com-
essential oil of Melaleuca alternifolia. Lett Appl
pared to two (13%) of the RC group. Adverse events
Microbiol 1993; 16: 49–55.
for the tea tree oil nasal ointment ranged from mild
3. Carson CF, Cookson BD, Farrelly HD, Riley TV.
swelling of the nasal mucosa to an acute burning
Susceptibility of methicillin-resistant Staphylococcus
upon application. One participant complained of
aureus to the essential oil of Melaleuca alternifolia. J Antimicrob Chemother 1995; 35: 421– 424.
skin tightness after using the triclosan body wash.
4. Carson CF, Riley TV, Cookson BD. Efficacy and
No adverse events were recorded for either the tea
safety of tea tree oil as a topical antimicrobial agent.
tree oil body wash or mupirocin nasal ointment. J Hosp Infect 1988; 40: 175–178.
5. Riley TV, Rouse IL. Methicillin-resistant Staphylo-coccus aureus in Western Australia, 1983–1992. J HospDiscussion Infect 1995; 29: 177–188.
6. Lacey R. Mutli-resistant Staphylococcus aureus – a
There has been much debate as to whether the con-
suitable case for inactivity? J Hosp Infect 1987; 9:
trol of MRSA is both worthwhile and feasible.
Various local and national policies have been
7. Barrett SP, Mummery RV, Chattopadhyay B. Trying
drafted which, with few exceptions (such as
to control MRSA causes more problems than it solves. J Hosp Infect 1999; 39: 85–93.
Western Australia5), have failed to achieve the
8. Papia G, Louie M, Tralla A, Johnson C, Collins V,
objective of controlling MRSA, particularly in the
Simor AE. Screening high-risk patients for methi-
large teaching hospital setting. Lacey6 argued early
cillin-resistant Staphylococcus aureus on admission to
on for abandoning expensive and time-consuming
the hospital: is it cost effective? Infect Control Hosp
strategies and putting more effort into reducing the
Epidemiol 1999; 20: 473–477.
9. Schmitz F-J, Jones ME. Antibiotics for treatment of
excessive and inappropriate antibiotic prescribing
infections caused by MRSA and elimination of MRSA
that selects for MRSA. Barrett et al.7 continued to
carriage. What are the choices? Int J Antimicrob
argue that the fight against MRSA was lost,
Agents 1997; 9: 1–19.
Most Patients With Ulcerative Colitis Remain in Remission After 12 Months of MMX Mesalamine Therapy PHILADELPHIA - November 2, 2007 - The majority of ulcerative colitis patients with both left- sided and extensive disease remain in remission after receiving once-daily mesalamine with multimatrix system (MMX mesalamine; Lialda , Shire US, Inc) as maintenance therapy for 12 months, a study
Verbale della terza riunione organizzativa "Cuba 2003" del 28/06/03 Alla riunione sono presenti R. Potenza, G. Campanella, D. Lovece, M. Parise, F. Maurano, U. Del Vecchio, Alle porte della prima scadenza del nostro lavoro, si sono affrontati i seguenti punti: 12. Coordinatore delle attività di topografia 14. Conservazione dei documenti elaborati Dai contatti con il responsabile