Essential Oil-Mediated Potentiation of Erythromycin Against Resistant and Sensitive Cutibacterium acnes: Implications for Antimicrobial Resistance Management
Main Article Content
Suzanne Abdelmalek
http://orcid.org/0000-0001-5401-6532
Yehya Al-Banna
http://orcid.org/0000-0003-2277-6371
Malak Hajar
Kenza Mansoor
http://orcid.org/0000-0002-8171-2055
Phillip J. Collier
http://orcid.org/0000-0001-8529-2548
http://orcid.org/0000-0001-5401-6532
Yehya Al-Banna
http://orcid.org/0000-0003-2277-6371
Malak Hajar
Kenza Mansoor
http://orcid.org/0000-0002-8171-2055
Phillip J. Collier
http://orcid.org/0000-0001-8529-2548
Abstract
Acne vulgaris, a chronic skin condition, is, in part, caused by the bacteria Cutibacterium acnes (C. acnes). Antibiotics are commonly used for treatment of this condition, but antibiotic resistance poses an increasing challenge for a successful outcome. This study aims to investigate the synergistic antimicrobial activity of tea tree oil (TTO), chamomile oil (CO), with erythromycin against clinical strains of erythromycin-sensitive and erythromycin-resistant strains of C. acnes. Twenty-one clinical samples of C. acnes were used. Minimum inhibitory concentrations (MIC) of TTO, CO, and erythromycin alone and in combination were investigated using microdilution and checkerboard assays. Synergistic interactions were evaluated using the Fraction Inhibitory Concentration Index (FICI). The mixture of TTO and CO combined with erythromycin showed a significant 95.97 % (P<0.05) reduction in MIC of erythromycin (FICI = 0.13), restoring this antibiotic activity on the erythromycin-resistant C. acnes. These results suggest using essential oil combinations simultaneously with conventional topical antimicrobials to treat Acne vulgaris.
Keywords:
Tea tree oil, Chamomile oil, C. acnes, Synergy, Antimicrobial Activity
Article Details
How to Cite
ABDELMALEK, Suzanne et al.
Essential Oil-Mediated Potentiation of Erythromycin Against Resistant and Sensitive Cutibacterium acnes: Implications for Antimicrobial Resistance Management.
Medical Research Archives, [S.l.], v. 13, n. 11, nov. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/7064>. Date accessed: 26 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i11.7064.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Suva M. A Brief Review on Acne Vulgaris: Pathogenesis, Diagnosis and Treatment. Research & Reviews: Journal of Pharmacology. 2015;4:1-12.
2. Mayslich C, Grange PA, Dupin N. Cutibacterium acnes as an Opportunistic Pathogen: An Update of Its Virulence-Associated Factors. Microorganisms. 2021;9(2):303. doi:10.3390/microorganisms9020303
3. Abdelmalek SM, Alowaissi J, Hamadi SA, Akkash L. Impact of Dermatologists’ Perceptions about Antibiotic Resistance on Antibiotic Prescribing for Acne. J Infect Dis Ther. 2016;4(5). doi:10.4172/2332-0877.1000294
4. Alkhawaja E, Hammadi S, Abdelmalek M, Mahasneh N, Alkhawaja B, Abdelmalek SM. Antibiotic resistant Cutibacterium acnes among acne patients in Jordan: a cross-sectional study. BMC Dermatology. 2020;20(1):17. doi:10.1186/s12895-020-00108-9
5. Schelz Z, Molnar J, Hohmann J. Antimicrobial and antiplasmid activities of essential oils. Fitoterapia. 2006;77(4):279-285. doi:10.1016/j.fitote.2006.03.013
6. Yap PSX, Yiap BC, Ping HC, Lim SHE. Essential Oils, A New Horizon in Combating Bacterial Antibiotic Resistance. Open Microbiol J. 2014;8:6-14. doi:10.2174/1874285801408010006
7. Carson CF, Hammer KA, Riley TV. Melaleuca alternifolia (Tea Tree) Oil: a Review of Antimicrobial and Other Medicinal Properties. Clin Microbiol Rev. 2006;19(1):50-62. doi:10.1128/CMR.19.1.50-62.2006
8. Hammer KA. Treatment of acne with tea tree oil (melaleuca) products: a review of efficacy, tolerability and potential modes of action. Int J Antimicrob Agents. 2015;45(2):106-110. doi:10.1016/j.ijantimicag.2014.10.011
9. Singh O, Khanam Z, Misra N, Srivastava MK. Chamomile (Matricaria chamomilla L.): An overview. Pharmacogn Rev. 2011;5(9):82-95. doi:10.4103/0973-7847.79103
10. Zu Y, Yu H, Liang L, et al. Activities of ten essential oils towards Propionibacterium acnes and PC-3, A-549 and MCF-7 cancer cells. Molecules. 2010;15(5): 3200-3210. doi:10.3390/molecules15053200
11. Shenefelt PD. Herbal Treatment for Dermatologic Disorders. In: Benzie IFF, Wachtel-Galor S, eds. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd ed. CRC Press/Taylor & Francis; 2011. Accessed October 18, 2023. http://www.ncbi.nlm.nih.gov/books/NBK92761/
12. van Vuuren S, Viljoen A. Plant-based antimicrobial studies--methods and approaches to study the interaction between natural products. Planta Med. 2011;77(11):1168-1182. doi:10.1055/s-0030-1250736
13. Cassella S, Cassella JP, Smith I. Synergistic antifungal activity of tea tree (Melaleuca alternifolia) and lavender (Lavandula angustifolia) essential oils against dermatophyte infection. International Journal of Aromatherapy. 2002;12(1):2-15. doi:10.1054/ijar.2001.0127
14. Moldovan M, Bogdan C, Ursu I, Ionescu Mi, Crișan M. Evaluation of The Efficacy And Characterization of An Anti-Acne Cream Containing Herbal Extracts Anti-Acne Cream Containing Herbal Extracts. FARMACIA. 2016;64.
15. WFO. Melaleuca alternifolia Cheel. Published on the Internet; http://www.worldfloraonline.org/taxon/wfo-0000239396. Accessed on: 23 Nov 2023’. Published online 2023.
16. WFO. Matricaria chamomilla var. chamomilla . Published on the Internet; http://www.worldfloraonline.org/taxon/wfo-0000099848. Accessed on: 23 Nov 2023’. Published online 2023.
17. Adams R. Identification of Essential Oil Components by Gas Chromatography / Mass Spectroscopy. Vol 16.; 1995.
18. ORAV A, KAILAS T, IVASK K. Volatile constituents of Matricaria recutita L. from Estonia. Proc Estonian Acad Sci Chem. 2001;50. doi:10.3176/chem.2001.1.05
19. Wagner H. Synergy research: approaching a new generation of phytopharmaceuticals. Fitoterapia. 2011;82(1):34-37. doi:10.1016/j.fitote.2010.11.016
20. Gandhi GR, Vasconcelos ABS, Haran GH, et al. Essential oils and its bioactive compounds modulating cytokines: A systematic review on anti-asthmatic and immunomodulatory properties. Phytomedicine. 2020;73:152854. doi:10.1016/j.phymed.2019.152854
21. Johnson SA, Rodriguez D, Allred K. A Systematic Review of Essential Oils and the Endocannabinoid System: A Connection Worthy of Further Exploration. Evid Based Complement Alternat Med. 2020;2020: 8035301. doi:10.1155/2020/8035301
22. Puvača N, Milenković J, Galonja Coghill T, et al. Antimicrobial Activity of Selected Essential Oils against Selected Pathogenic Bacteria: In Vitro Study. Antibiotics (Basel). 2021;10(5):546. doi:10.3390/antibiotics10050546
23. Khalil Z, Pearce AL, Satkunanathan N, Storer E, Finlay-Jones JJ, Hart PH. Regulation of Wheal and Flare by Tea Tree Oil: Complementary Human and Rodent Studies. Journal of Investigative Dermatology. 2004;123(4):683-690. doi:10.1111/j.0022-202X. 2004.23407.x
24. Kamatou GPP, Viljoen AM. A Review of the Application and Pharmacological Properties of α-Bisabolol and α-Bisabolol-Rich Oils. Journal of the American Oil Chemists’ Society. 2010;87(1):1-7. doi:10.1007/s11746-009-1483-3
25. Das S, Horváth B, Šafranko S, Jokić S, Széchenyi A, Kőszegi T. Antimicrobial Activity of Chamomile Essential Oil: Effect of Different Formulations. Molecules. 2019;24(23):4321. doi:10.3390/molecules24234321
26. Iacovelli F, Romeo A, Lattanzio P, et al. Deciphering the Broad Antimicrobial Activity of Melaleuca alternifolia Tea Tree Oil by Combining Experimental and Computational Investigations. International Journal of Molecular Sciences. 2023;24(15):12432. doi:10.3390/ijms241512432
27. KIM SS, BAIK JS, OH TH, YOON WJ, LEE NH, HYUN CG. Biological Activities of Korean Citrus obovoides and Citrus natsudaidai Essential Oils against Acne-Inducing Bacteria. Bioscience, Biotechnology, and Biochemistry. 2008;72(10):2507-2513. doi:10.1271/bbb.70388
28. Johansen B, Duval RE, Sergere JC. First Evidence of a Combination of Terpinen-4-ol and α-Terpineol as a Promising Tool against ESKAPE Pathogens. Molecules. 2022;27(21):7472. doi:10.3390/molecules27217472
29. Nair A, Mallya R, Suvarna V, Khan TA, Momin M, Omri A. Nanoparticles—Attractive Carriers of Antimicrobial Essential Oils. Antibiotics (Basel). 2022;11(1):108. doi:10.3390/antibiotics11010108
30. Kapoor S, Saraf ProfS. Topical Herbal Therapies an Alternative and Complementary Choice to Combat Acne. Research Journal of Medicinal Plant. 2011;5:650-669. doi:10.3923/rjmp.2011.650.669
31. Rosato A, Vitali C, De Laurentis N, Armenise D, Antonietta Milillo M. Antibacterial effect of some essential oils administered alone or in combination with Norfloxacin. Phytomedicine. 2007;14(11):727-732. doi:10.1016/j.phymed.2007.01.005
32. Rosato A, Vitali C, Gallo D, Balenzano L, Mallamaci R. The inhibition of Candida species by selected essential oils and their synergism with amphotericin B. Phytomedicine. 2008;15(8):635-638. doi:10.1016/j.phymed.2008.05.001
33. Christoph F, Kaulfers PM, Stahl-Biskup E. In vitro evaluation of the antibacterial activity of beta-triketones admixed to Melaleuca oils. Planta Med. 2001;67(8):768-771. doi:10.1055/s-2001-18350
34. Lim YH, Kim IH, Seo JJ. In vitro activity of kaempferol isolated from the Impatiens balsamina alone and in combination with erythromycin or clindamycin against Propionibacterium acnes. J Microbiol. 2007;45(5):473-477.
2. Mayslich C, Grange PA, Dupin N. Cutibacterium acnes as an Opportunistic Pathogen: An Update of Its Virulence-Associated Factors. Microorganisms. 2021;9(2):303. doi:10.3390/microorganisms9020303
3. Abdelmalek SM, Alowaissi J, Hamadi SA, Akkash L. Impact of Dermatologists’ Perceptions about Antibiotic Resistance on Antibiotic Prescribing for Acne. J Infect Dis Ther. 2016;4(5). doi:10.4172/2332-0877.1000294
4. Alkhawaja E, Hammadi S, Abdelmalek M, Mahasneh N, Alkhawaja B, Abdelmalek SM. Antibiotic resistant Cutibacterium acnes among acne patients in Jordan: a cross-sectional study. BMC Dermatology. 2020;20(1):17. doi:10.1186/s12895-020-00108-9
5. Schelz Z, Molnar J, Hohmann J. Antimicrobial and antiplasmid activities of essential oils. Fitoterapia. 2006;77(4):279-285. doi:10.1016/j.fitote.2006.03.013
6. Yap PSX, Yiap BC, Ping HC, Lim SHE. Essential Oils, A New Horizon in Combating Bacterial Antibiotic Resistance. Open Microbiol J. 2014;8:6-14. doi:10.2174/1874285801408010006
7. Carson CF, Hammer KA, Riley TV. Melaleuca alternifolia (Tea Tree) Oil: a Review of Antimicrobial and Other Medicinal Properties. Clin Microbiol Rev. 2006;19(1):50-62. doi:10.1128/CMR.19.1.50-62.2006
8. Hammer KA. Treatment of acne with tea tree oil (melaleuca) products: a review of efficacy, tolerability and potential modes of action. Int J Antimicrob Agents. 2015;45(2):106-110. doi:10.1016/j.ijantimicag.2014.10.011
9. Singh O, Khanam Z, Misra N, Srivastava MK. Chamomile (Matricaria chamomilla L.): An overview. Pharmacogn Rev. 2011;5(9):82-95. doi:10.4103/0973-7847.79103
10. Zu Y, Yu H, Liang L, et al. Activities of ten essential oils towards Propionibacterium acnes and PC-3, A-549 and MCF-7 cancer cells. Molecules. 2010;15(5): 3200-3210. doi:10.3390/molecules15053200
11. Shenefelt PD. Herbal Treatment for Dermatologic Disorders. In: Benzie IFF, Wachtel-Galor S, eds. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd ed. CRC Press/Taylor & Francis; 2011. Accessed October 18, 2023. http://www.ncbi.nlm.nih.gov/books/NBK92761/
12. van Vuuren S, Viljoen A. Plant-based antimicrobial studies--methods and approaches to study the interaction between natural products. Planta Med. 2011;77(11):1168-1182. doi:10.1055/s-0030-1250736
13. Cassella S, Cassella JP, Smith I. Synergistic antifungal activity of tea tree (Melaleuca alternifolia) and lavender (Lavandula angustifolia) essential oils against dermatophyte infection. International Journal of Aromatherapy. 2002;12(1):2-15. doi:10.1054/ijar.2001.0127
14. Moldovan M, Bogdan C, Ursu I, Ionescu Mi, Crișan M. Evaluation of The Efficacy And Characterization of An Anti-Acne Cream Containing Herbal Extracts Anti-Acne Cream Containing Herbal Extracts. FARMACIA. 2016;64.
15. WFO. Melaleuca alternifolia Cheel. Published on the Internet; http://www.worldfloraonline.org/taxon/wfo-0000239396. Accessed on: 23 Nov 2023’. Published online 2023.
16. WFO. Matricaria chamomilla var. chamomilla . Published on the Internet; http://www.worldfloraonline.org/taxon/wfo-0000099848. Accessed on: 23 Nov 2023’. Published online 2023.
17. Adams R. Identification of Essential Oil Components by Gas Chromatography / Mass Spectroscopy. Vol 16.; 1995.
18. ORAV A, KAILAS T, IVASK K. Volatile constituents of Matricaria recutita L. from Estonia. Proc Estonian Acad Sci Chem. 2001;50. doi:10.3176/chem.2001.1.05
19. Wagner H. Synergy research: approaching a new generation of phytopharmaceuticals. Fitoterapia. 2011;82(1):34-37. doi:10.1016/j.fitote.2010.11.016
20. Gandhi GR, Vasconcelos ABS, Haran GH, et al. Essential oils and its bioactive compounds modulating cytokines: A systematic review on anti-asthmatic and immunomodulatory properties. Phytomedicine. 2020;73:152854. doi:10.1016/j.phymed.2019.152854
21. Johnson SA, Rodriguez D, Allred K. A Systematic Review of Essential Oils and the Endocannabinoid System: A Connection Worthy of Further Exploration. Evid Based Complement Alternat Med. 2020;2020: 8035301. doi:10.1155/2020/8035301
22. Puvača N, Milenković J, Galonja Coghill T, et al. Antimicrobial Activity of Selected Essential Oils against Selected Pathogenic Bacteria: In Vitro Study. Antibiotics (Basel). 2021;10(5):546. doi:10.3390/antibiotics10050546
23. Khalil Z, Pearce AL, Satkunanathan N, Storer E, Finlay-Jones JJ, Hart PH. Regulation of Wheal and Flare by Tea Tree Oil: Complementary Human and Rodent Studies. Journal of Investigative Dermatology. 2004;123(4):683-690. doi:10.1111/j.0022-202X. 2004.23407.x
24. Kamatou GPP, Viljoen AM. A Review of the Application and Pharmacological Properties of α-Bisabolol and α-Bisabolol-Rich Oils. Journal of the American Oil Chemists’ Society. 2010;87(1):1-7. doi:10.1007/s11746-009-1483-3
25. Das S, Horváth B, Šafranko S, Jokić S, Széchenyi A, Kőszegi T. Antimicrobial Activity of Chamomile Essential Oil: Effect of Different Formulations. Molecules. 2019;24(23):4321. doi:10.3390/molecules24234321
26. Iacovelli F, Romeo A, Lattanzio P, et al. Deciphering the Broad Antimicrobial Activity of Melaleuca alternifolia Tea Tree Oil by Combining Experimental and Computational Investigations. International Journal of Molecular Sciences. 2023;24(15):12432. doi:10.3390/ijms241512432
27. KIM SS, BAIK JS, OH TH, YOON WJ, LEE NH, HYUN CG. Biological Activities of Korean Citrus obovoides and Citrus natsudaidai Essential Oils against Acne-Inducing Bacteria. Bioscience, Biotechnology, and Biochemistry. 2008;72(10):2507-2513. doi:10.1271/bbb.70388
28. Johansen B, Duval RE, Sergere JC. First Evidence of a Combination of Terpinen-4-ol and α-Terpineol as a Promising Tool against ESKAPE Pathogens. Molecules. 2022;27(21):7472. doi:10.3390/molecules27217472
29. Nair A, Mallya R, Suvarna V, Khan TA, Momin M, Omri A. Nanoparticles—Attractive Carriers of Antimicrobial Essential Oils. Antibiotics (Basel). 2022;11(1):108. doi:10.3390/antibiotics11010108
30. Kapoor S, Saraf ProfS. Topical Herbal Therapies an Alternative and Complementary Choice to Combat Acne. Research Journal of Medicinal Plant. 2011;5:650-669. doi:10.3923/rjmp.2011.650.669
31. Rosato A, Vitali C, De Laurentis N, Armenise D, Antonietta Milillo M. Antibacterial effect of some essential oils administered alone or in combination with Norfloxacin. Phytomedicine. 2007;14(11):727-732. doi:10.1016/j.phymed.2007.01.005
32. Rosato A, Vitali C, Gallo D, Balenzano L, Mallamaci R. The inhibition of Candida species by selected essential oils and their synergism with amphotericin B. Phytomedicine. 2008;15(8):635-638. doi:10.1016/j.phymed.2008.05.001
33. Christoph F, Kaulfers PM, Stahl-Biskup E. In vitro evaluation of the antibacterial activity of beta-triketones admixed to Melaleuca oils. Planta Med. 2001;67(8):768-771. doi:10.1055/s-2001-18350
34. Lim YH, Kim IH, Seo JJ. In vitro activity of kaempferol isolated from the Impatiens balsamina alone and in combination with erythromycin or clindamycin against Propionibacterium acnes. J Microbiol. 2007;45(5):473-477.