The antivirulence compound myricetin possesses remarkable synergistic effect with antibacterials upon multidrug resistant Staphylococcus aureus.

Staphylococcus aureus is an opportunistic pathogen involved in several human diseases and presents ability to produce many virulence factors and resistance to antibacterial agents. One of the current strategies to combat such multidrug resistant bacteria is the antibacterial combination therapy. Myricetin is a flavonoid capable of inhibiting several S. aureus virulence factors without influencing on bacterial growth. Therefore, the combination of antibacterials with the antivirulence compound myricetin may provide a positive interaction to control multidrug resistant-bacteria. This work aims to evaluate the effect of the combination of myricetin with oxacillin and vancomycin against methicillin resistant S. aureus (MRSA) and vancomycin intermediate resistant S. aureus (VISA) strains. Concentrations used in combination assays were determined according to the minimum inhibitory concentration (MIC) for antibacterials and to the biofilm minimum inhibitory concentration (BMIC) for myricetin. Checkerboard evaluations showed reduction in MIC for antibacterials in presence of myricetin and time-kill assays confirmed the synergism for these combinations, except for VISA strain when the flavonoid was combined with vancomycin. Importantly, when myricetin was combined with oxacillin, MRSA strain became susceptible to the antibacterial. Myricetin did not reduce staphyloxanthin production, indicating that the oxacillin susceptibility seems not to be related to this step of functional membrane microdomains. In vivo evaluations using Galleria mellonella confirmed the efficacy of oxacillin plus myricetin in treatment of MRSA infected-larvae when compared to the control groups, increasing in 20% host survival. The present work points out the potential of antibacterial and antivirulence compounds combinations as new alternative to control infections by multidrug resistant-bacteria.