Synergistic effect between vancomycin and traditional Chinese medicine (TCM) herbs against methicillin-resistant Staphylococcus aureus (MRSA) infections

Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant challenge to global health due to its resistance to many conventional antibiotics. Emerging resistance increasingly compromises the efficacy of vancomycin, a glycopeptide antibiotic, which remains a critical treatment option for MRSA infections. Traditional Chinese Medicine (TCM), with its rich history and diverse pharmacopoeia, offers potential complementary therapies. This review explores the synergistic effects of combining vancomycin with TCM to enhance antibacterial efficacy against MRSA. We conducted a comprehensive literature review using databases such as PubMed, Scopus, and Web of Science. Studies included were those that evaluated the combined effects of vancomycin and Traditional Chinese Medicine (TCM) on MRSA in vitro, in vivo, and in clinical settings. Our selection criteria focused on peer-reviewed articles published in the last two decades. We included studies that provided clear methodologies for assessing bacterial inhibition rates, synergy assessments (using methods such as the checkerboard assay and time-kill curves), and mechanisms of action. Additionally, studies were required to detail the specific TCM components used, dosages, and outcomes. We excluded studies that did not specifically assess the combination of vancomycin with TCM, lacked a control group, or did not provide sufficient methodological details for assessing the synergy between the treatments. Data extraction was standardized to include study design, TCM components used, dosages, and outcomes. The review identified several TCM herbs and formulations that exhibited synergistic effects when combined with vancomycin. Notable examples include Huang Lian (Coptis chinensis), which demonstrated enhanced bacterial inhibition through disruption of bacterial cell walls and biofilm reduction. The combination therapy not only improved bacterial clearance but also reduced the required dosage of vancomycin, potentially mitigating adverse effects. Mechanistic studies showed that TCM compounds could make bacterial cell membranes more permeable and stop efflux pumps from working, which raised the concentration of vancomycin inside cells. The synergistic use of vancomycin and TCM offers a promising strategy to combat MRSA infections, potentially addressing the limitations of vancomycin monotherapy. This review highlights the need for further clinical trials to validate these findings and optimise combination protocols. Integrating TCM with conventional antibiotics could lead to more effective, lower-dose treatments, reducing the risk of resistance development and improving patient outcomes. Future research should focus on elucidating the precise mechanisms of synergy and exploring the clinical applicability of these combinations.