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
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, Australia Summary: 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.
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 Acknowledgements
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- References
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.
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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.
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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.
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