Potent activity of the lichen antibiotic (+)-usnic acid against clinical isolates of vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus

Vancomycin-resistant enterococci (VRE) and methicillin-resistant staphylococci, most notably methicillin-resistant Staphylococcus aureus (MRSA), are serious clinical problems. The antibiotic arsenal available against them is limited, and new mutants worsen the situation. We studied the activity of (+)-usnic acid, an old lichen-derived drug, and its sodium salt against clinical isolates of VRE and MRSA using the agar diffusion and minimal inhibitory concentration (MIC) methods. The acid and, especially, the sodium salt had potent antimicrobial activity against all clinical isolates of VRE and MRSA studied. The MIC values of the sodium salt against VRE strains ranged between 4 and 16 mu g/ml (1-day test) and between 4 and 31 mu g/ml (2-day test), being below 8 mu g/ml for most strains. The salt had potent activity even against those strains that were not inhibited by ampicillin (125 mu g/ml), and it never lost its activity after 24 h, in contrast to ampicillin. Thus, in spite of the fact that usnic acid can in some cases cause serious toxicity, it and its salts may be worth considering in clinical practice in cases where other therapies have failed or the microbe is resistant toward other agents.