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Cutibacterium acnes, Staphylococcus epidermidis, and Staphylococcus aureus proliferate within accumulated sebum and produce localised inflammation thereby inducing acne vulgaris. Essential oils are one of the leading natural products used for acne and are diluted in fixed oils to reduce irritation and toxicity. This study investigated the in vitro antimicrobial, anti-inflammatory, cytotoxicity, and skin retention properties of Rosa rubiginosa rosehip fixed oil in combination with essential oils having activity against acne vulgaris. The broth microdilution assay was used to determine the minimum inhibitory concentration (MIC), and the sum of the fractional inhibitory concentration index (ΣFIC) was calculated for the interactions. The lipopolysaccharide (LPS) induced inflammatory pathway in RAW 264.7 macrophages was used to assess anti-inflammatory activity. A dual-staining method in A549 epithelial cells was used to assess cytotoxicity. Qualitative Fourier Transform Infrared spectroscopy analysis was used for initial skin retention determination. Rosa rubiginosa oil combined with Cinnamomum zeylanicum essential oil displayed antimicrobial synergy (MIC = 0.42 mg/ mL; ΣFIC = 0.45) against three acne-inducing strains. Rosa rubiginosa fixed oil combined with Styrax benzoin essential oil suppressed LPS-induced nitrite production by 33.80%. Rosa rubiginosa oil combined with Melaleuca quinquenervia essential oil exhibited the lowest cytotoxicity (84.32% cell viability). Rosa rubiginosa oil combined with either C. zeylanicum, Eugenia caryophyllata, Rosa damascena or S. benzoin essential oil was retained within the porcine skin. Rosa rubiginosa fixed oil serves as an ideal carrier oil that can potentiate selected essential oils for the treatment of acne vulgaris. [ABSTRACT FROM AUTHOR]

Aims Antimicrobial resistance continues to be a growing concern, resulting in increased use of drug combinations. Antibiotic adjuvants are an emerging strategy that may potentiate an antibiotics efficacy. Ibuprofen's polypharmacological properties have been investigated for their antimicrobial and host-modulating potential. This study aimed to investigate the potential of a novel multidrug combination involving ibuprofen, essential oil compounds (EOCs), and conventional antimicrobials against skin pathogens. Methods and Results The minimum inhibitory concentrations of ibuprofen, conventional antimicrobials, and EOCs were determined and then combined and tested against 14 (reference and clinical) skin pathogens. The cytotoxicity was analysed using the MTT assay, whilst the anti-inflammatory effects were evaluated using lipopolysaccharide activated RAW264.7 murine macrophages. Four pairwise (Ibuprofen and antibiotic) (ΣFIC 0.33–0.50) and three triple (Ibuprofen and antibiotic with EOC) (ΣFIC 0.44–0.47) synergistic antimicrobial interactions were identified. These combinations demonstrated cell viability of 77.59%–100%. No combination significantly reduced nitric oxide production. Conclusion The results from this study provide insight into the potential of a multidrug combination involving ibuprofen with conventional antimicrobials and EOCs against common skin pathogens. [ABSTRACT FROM AUTHOR]

Fungal infections present a challenge when it comes to topical treatment failure thereby necessitating the need for more effective topical delivery systems. Essential oils have demonstrated noteworthy antifungal activity; however, their volatility limits therapeutic use for skin conditions. This study aimed to investigate the antifungal activity of essential oils alone and in combination. Thereafter, antifungal nanoparticulate formulations were designed using three essential oil combinations against Microsporum canis, Trichophyton mentagrophytes and Candida albicans. The antifungal activity was investigated using the broth microdilution assay to determine the minimum inhibitory concentration (MIC). The formulations were prepared by forming nanoparticles (polymer-based and composite lipid-polymer-based systems), with the preferred formulation encapsulating the essential oil combinations. Characterisation of the formulations was performed with a Zeta-sizer and using attenuated total reflectance-fourier transform infrared spectroscopy (ATR-FTIR). The in vitro antifungal activity of the three nanoparticulate formulations was then determined, where a significant (p = 0.002) increase in the average antidermatophyte activity could be observed for all three formulations. The combination of A. sativum and C. martinii displayed the lowest MIC value across all three reference strains (MIC values 0.06-0.38 mg mL-1) and the formulation maintained the antifungal activity with MIC values ranging 0.08-0.36 mg mL-1. A successful combination of essential oils with antifungal activity was achieved thereby emphasising an effective nanoparticulate formulation. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance has emerged as a significant threat to public health, prompting novel combinations comprising of natural sources such as essential oil compounds with conventional antibiotics. This study aimed to determine the possible interactions between six essential oil compounds with eight antibiotics/antifungals against six pathogens (Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Acinetobacter baumannii, Cutibacterium acnes, and Candida albicans) commonly implicated in skin infections. The minimum inhibitory concentrations (MICs) for the antibiotics and essential oil compounds were evaluated singularly and in combination using the broth microdilution assay. The fractional inhibitory concentrations (FIC) were calculated to determine the interactive profile of the combinations. The synergistic interactions (FIC ≤ 0.5) were further analysed at varying ratios and depicted on isobolograms. The toxicity of the synergistic combinations was determined using the brine shrimp lethality assay. Eight synergistic interactions were identified against the selected Gram-positive and P. aeruginosa pathogens, and the combinations also demonstrated a reduced toxicity. The combination of amoxicillin and eugenol demonstrated the lowest toxicity (LC50 = 1081 µg/mL) and the highest selectivity index (14.41) when in a 70:30 ratio. This study provides insight into the in vitro antimicrobial interactions of essential oil compounds and conventional antibiotics that can form a basis for newer therapies. [ABSTRACT FROM AUTHOR]

Introduction: the global rise in antibiotic resistance (ABR), coupled with a dry pipeline for the discovery of new antibiotics requires the conservation of currently available antibiotics. Antimicrobial stewardship (AMS) interventions are being implemented to optimize antibiotic use including the use of antibiotic prescription charts. This study reviewed the use of antibiotics before and after the introduction of an antibiotic prescription chart in a paediatric medical ward of an academic tertiary hospital in Johannesburg. Methods: a crosssectional retrospective review of patient records was conducted for patients admitted to a paediatric medical ward of an academic tertiary hospital over two study periods; before and after the introduction of an antibiotic prescription chart. Data were captured on a Microsoft® Excel (2010) spreadsheet and analyzed using Stata/IC 15.1 (StataCorp, USA). Results: antibiotic use decreased significantly by 7.04% following the introduction of the antibiotic prescription chart (p=0.027). Fields often left unfilled on the antibiotic prescription chart include age (100%), a record of renal function (GFR/CrCl) (97.46%), time of antibiotic prescribing (83.62%) and a record of culture and sensitivity results (80.17%). Conclusion: the findings of this study show an improvement in antibiotic use, the frequency of culture and sensitivity testing and documentation of relevant parameters after the introduction of the antibiotic prescription chart. The use of an antibiotic prescription chart is a practical way to achieve optimal antibiotic use and to encourage proper detailing of the clinical components necessary for antibiotic selection in a hospital setting in a developing country. [ABSTRACT FROM AUTHOR]

Viola odorata L. oil is frequently recommended in the aromatherapeutic literature for treating respiratory, urinary, and skin infections; however, antimicrobial evidence is lacking. In addition, in aromatherapy, combinations of essential oils are predominantly utilized with the goal of achieving therapeutic synergy, yet no studies investigating the interaction of essential oil combinations with V. odorata oil exists. This study thus aimed to address these gaps by investigating the antimicrobial activity of three Viola odorata oil samples, sourced from different suppliers, independently and in combination with 20 different commercial essential oils, against micro-organisms involved in respiratory, skin, and urinary tract infections associated with global resistance trends. These pathogens include several of the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) The chemical profile of the oils was determined using gas chromatography coupled with mass spectrometry. The minimum inhibitory concentrations (MIC) were determined using the broth micro-dilution method. The interactive profiles for the combinations were assessed by calculating the fractional inhibitory concentration index (ΣFIC). The main compounds varied across the three samples, and included phenethyl alcohol, isopropyl myristate, 2-nonynoic acid, methyl ester, α-terpineol, α-cetone, and benzyl acetate. The V. odorata oil samples displayed overall poor antimicrobial activity when tested alone; however, the antimicrobial activity of the combinations resulted in 55 synergistic interactions where the combination with Santalum austrocaledonicum resulted in the lowest MIC values as low as 0.13 mg/mL. The frequency of the synergistic interactions predominantly occurred against Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterococcus faecium with noteworthy MIC values ranging from 0.25–1.00 mg/mL. This study also reports on the variability of V. odorata oils sold commercially. While this warrants caution, the antimicrobial benefit in combination provides an impetus for further studies to investigate the therapeutic potential. [ABSTRACT FROM AUTHOR]

Essential oil compounds have been identified as alternative antimicrobials; however, their use is limited due to their toxicity on human lymphocytes, skin, and reproduction. Carrier oils can reduce the toxicity of essential oils, which raises the question as to whether such activity would extend to the essential oil compounds. Thus, this study aimed to investigate the antimicrobial and toxicity activity of essential oil compounds in combination with carrier oils. The antimicrobial properties of the essential oil compounds, alone and in combination with carrier oils, were determined using the broth microdilution assay. The toxicity was determined using the brine shrimp lethality assay. Antimicrobial synergy (ΣFIC ≤ 0.50) occurred in 3% of the samples when tested against the ESKAPE pathogens. The compound thymoquinone in combination with the carrier oil Prunus armeniaca demonstrated broad-spectrum synergistic activity and a selectivity index above four, highlighting this combination as the most favorable. The carrier oils reduced the toxicity of several compounds, with Calendula officinalis and P. armeniaca carrier oils being responsible for the majority of the reduced toxicity observed. This study provides insight into the interactions that may occur when adding a carrier oil to essential oil compounds. [ABSTRACT FROM AUTHOR]

Background: Vaccination falls within the scope of practice of a pharmacist and the coronavirus disease 2019 pandemic has seen an increase in pharmacies providing vaccination services. These vaccines are not without risk of allergic reactions and anaphylaxis. The available guidelines for the management of anaphylaxis include the administration of intravenous (IV) fluids. However, IV administration does not fall within the scope of practice of a pharmacist. A gap was identified in the availability of guidelines for the management of anaphylaxis without the use of IV fluid administration. Aim: This review aimed to address this gap by describing the mechanisms of allergic reactions and anaphylaxis and developing an algorithm to assist pharmacy personnel to manage these within the scope of practice. Methods: The authors used the recommendations for developing guidelines. Results: The availability of anaphylaxis guidelines and clinical studies catering for anaphylaxis and allergy management by pharmacists was deficient, thus the review modified the available management guidelines to align the management of allergy and anaphylaxis within the scope of a pharmacist. The items required for the management were also identified and listed as items that form part of the emergency tray in the pharmacy. Conclusion: The review designed algorithms based on the available literature to assist pharmacy personnel to manage allergy and anaphylaxis within the relevant scope of practice. The review also lists the equipment needed for an emergency tray. Contribution: This review serves to offer guidance for the management of allergy and anaphylaxis in a pharmacy setting. [ABSTRACT FROM AUTHOR]

The topical use of essential oils requires dilution into a carrier oil; however, scientific evidence regarding the antimicrobial efficacy and cytotoxicity when a carrier oil is combined with an essential oil is lacking. This study sets out to determine the antimicrobial activity and cytotoxicity of 23 essential oils combined with six known carrier oils. Gas chromatography- mass spectrometry/flame ionization detector (GC-MS/FID) was used to characterize the methyl esters of the carrier oils. The antimicrobial activity of the carrier oils alone and in combination with the essential oils was investigated using the broth microdilution assay against 11 skin pathogens and the cytotoxicity was determined using the brine shrimp lethality assay. The interactive profiles of the combinations for both antimicrobial activity and the cytotoxicity were analysed and calculated using the fractional inhibitory concentration index (SFIC). The carrier oils demonstrated no antimicrobial antagonism when combined with the essential oils and the overall cytotoxicity of the majority of the combinations was decreased. The carrier oils that could be identified as enhancing the antimicrobial activity and decreasing the cytotoxicity were Aloe Vera (Aloe vera Mill.) and Jojoba (Simmondsia chinensis C.K. Schneid) oil, with an overall reduction in essential oil cytotoxicity of 87.5% at 24 hrs and 85% at 48 hrs by Aloe Vera. Five of the essential oils (when diluted in Aloe Vera and Jojoba carrier oils) demonstrated enhanced antimicrobial activity against pathogens such as Brevibacterium epidermidis, B. linens, and P. aeruginosa with MIC values ranging from 0.09 to 0.50 mg/mL (and SFIC 0.14-0.39). The study could conclude that the carrier oils are complementary to essential oil formulations, mostly reducing cytotoxicity and in some cases enhancing the antimicrobial activity. [ABSTRACT FROM AUTHOR]

Wounds are a common medical infliction. With the increase in microbial resistance and a shift of interest towards complementary medicines, essential oils have been shown to be beneficial in suppressing microbial growth. However, in practice, essential oils are more often diluted into a base due to the risk of topical adverse effects, such as dermatitis. There is a lack of collated evidence-based information on toxicity and efficacy of carrier oils. The current information on the subject matter is restricted to generic, aroma-therapeutic books and pamphlets, based on anecdotal evidence rather than an experimental approach. Therefore, this review aimed at identifying the recommended carrier oils used in dermatology and thereafter collating the scientific evidence to support the use of carrier oils together with essential oils recommended for dermatological use. Aloe vera gel had multiple studies demonstrating the ability to enhance wound healing; however, several other carrier oils have been largely neglected. It was observed that the extracts for certain plant species had been used to justify the use of the carrier oils of the same plant species. This is an inaccurate cross assumption due to the difference in chemical composition and biological activities. Lastly, despite these carrier oils being recommended as a base for essential oils, very little data was found on the interactive profile of the carrier oil with the essential oil. This review provides a platform for further studies, especially if essential oils are to receive credence in the scientific field. [ABSTRACT FROM AUTHOR]