In vitro synergism between berberine and miconazole against planktonic and biofilm Candida cultures

Abstract Objectives To investigate the antimycotic activity of the plant alkaloid berberine (BBR), alone and in combination with antifungal azoles, against planktonic and biofilm Candida cultures. Design The minimum inhibitory concentrations (MICs) of BBR, miconazole (MCZ), and fluconazole (FLC) towards Candida albicans , Candida glabrata , Candida kefyr , Candida krusei , Candida parapsilosis , and Candida tropicalis were determined by a microdilution method. For C. albicans , the synergistic effects of BBR combined with MCZ or FLC were examined in a paper disc agar diffusion assay and checkerboard microdilution assay. The effect of the BBR/MCZ combination was further investigated in a C. albicans biofilm formation model with a dual-chamber flow cell. The effect on metabolic activity of biofilm cells was established using 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT)/menadione. Results Berberine inhibited the growth of various Candida species (MICs 0.98–31.25 mg/L) in the following order of susceptibility: C. krusei > C. kefyr > C. glabrata > C. tropicalis > C. parapsilosis and C. albicans. Synergism between BBR and MCZ or FLC was observed in the disc diffusion assay as well as in suspension showing an FIC index 91% after 24 h, as established from the reduction in surface area coverage ( P < 0.01). The BBR/MCZ combination also exhibited synergy against the metabolic activity of pre-formed C. albicans biofilms in polystyrene microtiter plates (∑FIC = 0.25). Conclusion Berberine exhibits synergistic effects with commonly used antimycotic drugs against C. albicans , either in planktonic or in biofilm growth phases.