Advertisement

Staphylococcus aureus and wounds: A review of tea tree oil as a promising antimicrobial

  • Linda Halcón
    Correspondence
    Reprint requests: Linda Halcón, PhD, MPH, RN, University of Minnesota School of Nursing, 6-101 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455.
    Affiliations
    From the School of Nursing, University of Minnesotaa and Minnesota Program in CAM Clinical Research, Berman Center for Outcomes and Clinical Research, Minneapolis Medical Research Foundation.b USA
    Search for articles by this author
  • Kelly Milkus
    Affiliations
    From the School of Nursing, University of Minnesotaa and Minnesota Program in CAM Clinical Research, Berman Center for Outcomes and Clinical Research, Minneapolis Medical Research Foundation.b USA
    Search for articles by this author

      Abstract

      Antibiotic-resistant bacteria continue to be a major health concern worldwide. In particular, Staphylococcus aureus, both methicillin-resistant and -sensitive, are of concern in their ability to cause difficult skin and underlying tissue infections. Melaleuca alternifolia oil (tea tree oil), an essential oil, has demonstrated promising efficacy in treating these infections. Tea tree oil has been used for centuries as a botanical medicine, and has only in recent decades surfaced in the scientific literature as a promising adjunctive wound treatment. Tea tree oil is antimicrobial, anti-inflammatory, and has demonstrated ability to activate monocytes. There are few apparent side effects to using tea tree oil topically in low concentrations, with contact dermatitis being the most common. Tea tree oil has been effective as an adjunctive therapy in treating osteomyelitis and infected chronic wounds in case studies and small clinical trials. There is a need for larger clinical trials to further examine efficacy of tea tree oil as an adjunctive wound therapy, as well as improved guidelines for developing plant-based medicines.
      To read this article in full you will need to make a payment

      References

        • Witte W.
        Antibiotic resistance in gram-positive bacteria: epidemiological aspects.
        J Antimicrob Chemother. 1999; 44: 1-9
        • Mulligan M.E.
        • Murray-Leisure K.A.
        • Ribner B.S.
        • et al.
        Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management.
        Am J Med. 1993; 94: 313-328
        • Gorak E.J.
        • Yamada S.M.
        • Brown J.D.
        Community-acquired methicillin-resistant Staphylococcus aureus in hospitalized adults and children without known risk factors.
        Clin Infect Dis. 1999; 29: 797-800
        • Blok H.E.
        • Vriens M.R.
        • Weersink A.J.
        • et al.
        Carriage of methicillin-resistant Staphylococcus aureus (MRSA) after discharge from hospital: follow-up for how long? A Dutch multi-centre study.
        J Hosp Infect. 2001; 48: 325-327
        • MacKinnon M.M.
        • Allen K.D.
        Long-term MRSA carriage in hospital patients.
        J Hosp Infect. 2000; 46: 216-221
        • Thomas M.J.
        Overview of resistance in the 1990's.
        Chest. 1999; 115: 3S-8S
        • Theaker C.
        • Ormond-Walshe S.
        • Azadian B.
        • et al.
        MRSA in the critically ill.
        J Hosp Infect. 2001; 48: 98-102
        • Tonge H.
        Special focus: tissue viability. The management of infected wounds.
        Nurs Standard. 1997; 12: 49-53
        • Wright J.B.
        • Lam K.
        • Burrell R.E.
        Wound management in an era of increasing bacterial antibiotic resistance: a role for topical silver treatment.
        Am J Infect Control. 1998; 26: 572-577
        • Chan C.H.
        • Loudon K.W.
        Activity of tea tree oil on methicillin-resistant Staphylococcus aureus (MRSA).
        J Hosp Infect. 1998; 39: 244-245
        • Arnold M.S.
        • Dempsey J.M.
        • Fishman M.
        • et al.
        The best hospital practices for controlling methicillin-resistant Staphylococcus aureus: on the cutting edge.
        Infect Control Hosp Epidemiol. 2002; 23: 69-76
        • Maple P.A.
        • Hamilton-Miller J.M.
        • Brumfitt W.
        Comparison of the in-vitro activities of the topical antimicrobials azelaic acid, nitrofurazone, silver sulphadiazine and mupirocin against methicillin-resistant Staphylococcus aureus.
        J Antimicrob Chemother. 1992; 29: 661-668
        • Riley T.V.
        • Carson C.F.
        • Bowman R.A.
        • et al.
        Mupirocin-resistant methicillin-resistant Staphylococcus aureus in Western Australia.
        Med J Aust. 1994; 161: 397-398
        • Irizarry L.
        • Merlin T.
        • Rupp J.
        • et al.
        Reduced susceptibility of methicillin-resistant Staphylococcus aureus to cetylpyridinium chloride and chlorhexidine.
        Chemotherapy. 1996; 42: 248-252
        • May J.
        • Chan C.H.
        • King A.
        • et al.
        Time-kill studies of tea tree oils on clinical isolates.
        J Antimicrob Chemother. 2000; 45: 639-643
        • Hayashi K.
        • Kamiya M.
        • Hayashi T.
        Virucidal effects of the steam distillate from Houttuynia cordata and its components on HSV-1, influenza virus, and HIV.
        Planta Med. 1995; 61: 237-241
        • Larrondo J.V.
        • Agut M.
        • Calvo-Torras M.A.
        Antimicrobial activity of essences from labiates.
        Microbios. 1995; 82: 171-172
        • Tirillini B.
        • Velasquez E.R.
        • Pellegrino R.
        Chemical composition and antimicrobial activity of essential oil of Piper angustifolium.
        Planta Med. 1996; 62: 372-373
        • Mikus J.
        • Harkenthal M.
        • Steverding D.
        • et al.
        In vitro effect of essential oils and isolated mono- and sesquiterpenes on Leishmania major and Trypanosoma brucei.
        Planta Med. 2000; 66: 366-368
        • Gustafson J.E.
        • Liew Y.C.
        • Chew S.
        • et al.
        Effects of tea tree oil on Escherichia coli.
        Lett Appl Microbiol. 1998; 26: 194-198
        • Shapiro S.
        • Meier A.
        • Guggenheim B.
        The antimicrobial activity of essential oils and essential oil components towards oral bacteria.
        Oral Microbiol Immunol. 1994; 9: 202-208
        • Carson C.F.
        • Riley T.V.
        Antimicrobial activity of tea tree oil.
        Rural Industries Research and Development Corporation, Nedlands, Western AustraliaJuly 1998
        • Serkedjieva J.
        • Hay A.J.
        In vitro anti-influenza virus activity of a plant preparation from Geranium sanguineum L.
        Antiviral Res. 1998; 37: 121-130
        • Maudsley F.
        • Kerr K.G.
        Microbiological safety of essential oils used in complementary therapies and the activity of these compounds against bacterial and fungal pathogens.
        Support Care Cancer. 1999; 7: 100-102
        • Carson C.F.
        • Hammer K.A.
        • Riley T.V.
        Broth micro-dilution method for determining the susceptibility of Escherichia coli and Staphylococcus aureus to the essential oil of Melaleuca alternifolia (tea tree oil).
        Microbios. 1995; 82: 181-185
        • Harkenthal M.
        • Reichling J.
        • Geiss H.K.
        • et al.
        Comparative study on the in vitro antibacterial activity of Australian tea tree oil, cajuput oil, niaouli oil, manuka oil, kanuka oil, and eucalyptus oil.
        Pharmazie. 1999; 54: 460-463
        • Pattnaik S.
        • Subramanyam V.R.
        • Bapaji M.
        • et al.
        Antibacterial and antifungal activity of aromatic constituents of essential oils.
        Microbios. 1997; 89: 39-46
        • Peana A.T.
        • Moretti M.D.
        • Juliano C.
        Chemical composition and antimicrobial action of the essential oils of Salvia desoleana and S. sclarea.
        Planta Med. 1999; 65: 752-754
        • Feinblatt H.M.
        Cajeput-type oil for the treatment of furunculosis.
        J Natl Med Assoc. 1960; 52: 32-34
        • Hammer K.A.
        • Carson C.F.
        • Riley T.V.
        In vitro susceptibilities of lactobacilli and organisms associated with bacterial vaginosis to Melaleuca alternifolia (tea tree) oil.
        Antimicrob Agents Chemother. 1999; 43: 196
        • Walker M.
        Clinical investigation of Australian Melaleuca Alternifolia oil for a variety of common foot problems.
        Curr Podiatry. 1972; : 28-34
        • Hammer K.A.
        • Carson C.F.
        • Riley T.V.
        Susceptibility of transient and commensal skin flora to the essential oil of Melaleuca alternifolia (tea tree oil).
        Am J Infect Control. 1996; 24: 186-189
        • Faoagali J.
        • George N.
        • Leditschke J.F.
        Does tea tree oil have a place in the topical treatment of burns?.
        Burns. 1997; 23: 349-351
        • Blackwell A.L.
        Tea tree oil and anaerobic (bacterial) vaginosis.
        Lancet. 1991; 337: 300
        • Bassett I.B.
        • Pannowitz D.L.
        • Barnetson R.S.
        A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne.
        Med J Aust. 1990; 153: 455-458
        • Carson C.F.
        • Cookson B.D.
        • Farrelly H.D.
        • et al.
        Susceptibility of methicillin-resistant Staphylococcus aureus to the essential oil of Melaleuca alternifolia.
        J Antimicrob Chemother. 1995; 35: 421-424
        • Nelson R.R.
        In-vitro activities of five plant essential oils against methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium.
        J Antimicrob Chemother. 1997; 40: 305-306
        • Nelson R.R.
        Selection of resistance to the essential oil of Melaleuca alternifolia in Staphylococcus aureus.
        J Antimicrob Chemother. 2000; 45: 549-550
        • Carson C.F.
        • Riley T.V.
        The antimicrobial activity of tea tree oil.
        Med J Aust. 1994; 160: 236
        • Christoph F.
        • Stahl-Biskup E.
        • Kaulfers P.-M.
        Death Kinetics of Staphylococcus aureus exposed to commercial tea tree oils s.l.
        J Essential Oils Res. 2001; 13: 98-102
        • Saller R.
        • Berger T.
        • Reichling J.
        • et al.
        Pharmaceutical and medicinal aspects of Australian tea tree oil.
        Phytomedicine. 1998; 5: 489-495
        • Satchell A.C.
        • Saurajen A.
        • Bell C.
        • et al.
        Treatment of interdigital tinea pedis with 25% and 50% tea tree oil solution: a randomized, placebo-controlled, blinded study.
        Australas J Dermatol. 2002; 45: 175-178
        • Tong M.M.
        • Altman P.M.
        • Barnetson R.S.
        Tea tree oil in the treatment of tinea pedis.
        Australas J Dermatol. 1992; 33: 145-149
        • Syed T.A.
        • Qureshi Z.A.
        • Ali S.M.
        • et al.
        Treatment of toenail onychomycosis with 2% butenafine and 5% Melaleuca alternifolia (tea tree) oil in cream.
        Trop Med Int Health. 1999; 4: 284-287
        • Buck D.S.
        • Nidorf D.M.
        • Addino J.G.
        Comparison of two topical preparations for the treatment of onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole.
        J Fam Pract. 1994; 38: 601-605
        • Satchell A.C.
        • Saurajen A.
        • Bell C.
        • et al.
        Treatment of dandruff with 5% tea tree oil shampoo.
        J Am Acad Dermatol. 2002; 47: 852-855
        • McCage C.M.
        • Ward S.M.
        • Paling C.A.
        • et al.
        Development of a paw paw herbal shampoo for the removal of head lice.
        Phytomedicine. 2002; 9: 743-748
        • Carson C.F.
        • Ashton L.
        • Dry L.
        • et al.
        Melaleuca alternifolia (tea tree) oil gel (6%) for the treatment of recurrent herpes labialis.
        J Antimicrob Chemother. 2001; 48: 450-451
        • Peña E.F.
        Melaleuca Alternifolia oil: Its use for trichomonal vaginitis and other vaginal infections.
        Obstet Gynecol. 1962; 19: 793-795
        • Groppo F.C.
        • Ramacciato J.C.
        • Simoes R.P.
        • et al.
        Antimicrobial activity of garlic, tea tree oil, and chlorhexidine against oral microorganisms.
        Int Dent J. 2002; 52: 433-437
        • Jandourek A.
        • Vaishampayan J.K.
        • Vazquez J.A.
        Efficacy of Melaleuca oral solution for the treatment of fluconazole refractory oral candidiasis in AIDS patients.
        AIDS. 1998; 12: 1033-1037
      1. Coldstream Plantation Pty Ltd. Tea tree oil. Available from: http://www.coldstream-plantation.com.au. Accessed January 24, 2003.

        • Council of Standards Australia
        Australian Standard AS2782: oil of Melaleuca, terpinen-4-ol type (tea tree oil).
        Council of Standards Australia, Committee CH/21, Essential Oils, Homebush, New South WalesAugust 1997
        • Elsom G.K.F.
        • Hide D.
        Susceptibility of methicillin-resistant Staphylococcus aureus to tea tree oil and mupirocin.
        J Antimicrob Chemother. 1999; 43: 427-428
        • Carson C.F.
        • Hammer K.A.
        • Riley T.V.
        In-vitro activity of the essential oil of Melaleuca alternifolia against Streptococcus spp.
        J Antimicrob Chemother. 1996; 37: 1177-1178
        • Banes-Marshall L.
        • Cawley P.
        • Phillips C.A.
        In vitro activity of Melaleuca alternifolia (tea tree) oil against bacterial and Candida spp. isolates from clinical specimens.
        Br J Biomed Sci. 2001; 58: 139-145
        • Southwell I.
        • Markham J.
        • Mann C.
        Significance of cineole for bioactivity and irritancy in tea tree oil.
        Rural Industries Research and Development Corporation, Nedlands, Western AustraliaFebruary 1997
        • Hinou J.B.
        • Harvala C.E.
        • Hinou E.B.
        Antimicrobial activity screening of 32 common constituents of essential oils.
        Pharmazie. 1989; 44: 302-303
        • Christoph F.
        • Kaulfers P.M.
        • Stahl-Biskup E.
        A comparative study of the in vitro antimicrobial activity of tea tree oils s.l. with special reference to the activity of beta-triketones.
        Planta Med. 2000; 66: 556-560
        • Knobloch K.
        • Weis N.
        • Weigard H.
        Mechanism of antimicrobial activity of essential oils.
        Planta Med. 1986; 52: 556-560
        • Carson C.F.
        • Mee B.J.
        • Riley T.V.
        Mechanism of action of Melaleuca alternifolia (tea tree) oil on Staphylococcus aureus determined by time-kill, lysis, leakage, and salt tolerance assays and electron microscopy.
        Antimicrob Agents Chemother. 2002; 46: 1914-1920
        • Cox S.D.
        • Gustafson J.E.
        • Mann C.M.
        • et al.
        Tea tree oil causes K+ leakage and inhibits respiration in Escherichia coli.
        Lett Appl Microbiol. 1998; 26: 355-358
        • Cox S.D.
        • Mann C.M.
        • Markham J.L.
        • et al.
        The mode of antimicrobial action on the essential oil of Melaleuca alternifolia (tea tree oil).
        J Appl Microbiol. 2000; 88: 170-175
        • Budhiraja S.S.
        • Cullum M.E.
        • Sioutis S.S.
        • et al.
        Biological activity of Melaleuca alternifolia (tea tree) oil component, terpinen-4-ol, in human myelocytic cell line HL-60.
        J Manipulative Physiolog Therap. 1999; 22: 447-453
        • Finlay-Jones J.
        • Hart P.
        • Riley T.
        • et al.
        Anti-inflammatory activity of tea tree oil.
        Rural Industries Research and Development Corporation, Nedlands, Western Australia2001
        • Hart P.H.
        • Brand C.
        • Carson C.F.
        • et al.
        Terpinen-4-ol, the main component of the essential oil of Melaleuca alternifolia (tea tree oil) suppresses inflammatory mediator production by activated human monocytes.
        Inflamm Res. 2000; 49: 619-626
        • Brand C.
        • Grimbaldeston M.A.
        • Gamble J.R.
        • et al.
        Tea tree oil reduces the swelling associated with the efferent phase of a contact hypersensitivity response.
        Inflamm Res. 2002; 51: 236-244
        • Brand C.
        • Townley S.L.
        • Finlay-Jones J.J.
        • et al.
        Tea tree oil reduces histamine-induced oedema in murine ears.
        Inflamm Res. 2002; 51: 283-289
        • Brand C.
        • Ferrante A.
        • Prager R.G.
        • et al.
        The water-soluble components of the essential oil of Melaleuca alternifolia (tea tree oil) suppress the production of superoxide by human monocytes, but not neutrophils, activated in vitro.
        Inflamm Res. 2001; 50: 213-219
        • Koh K.J.
        • Pearce A.L.
        • Marshman G.
        • et al.
        Tea tree oil reduces histamine-induced skin inflammation.
        Br J Dermatol. 2002; 147: 1212-1217
        • Gustafson J.E.
        • Cox S.D.
        • Liew Y.C.
        • et al.
        The bacterial multiple antibiotic resistant (Mar) phenotype leads to increased tolerance to tea tree oil.
        Pathology. 2001; 33: 211-215
        • Aono R.
        • Kobayashi H.
        Cell surface properties of organic solvent-tolerant mutants of Escherichia coli K-12.
        Appl Environ Microbiol. 1997; 63: 3637-3642
        • Okusu H.
        • Ma D.
        • Nikaido H.
        AcrAB efflux pump plays a major role in the antibiotic resistance phenotype of Escherichia coli multiple-antibiotic-resistance (Mar) mutants.
        J Bacteriol. 1996; 178: 306-308
        • White D.G.
        • Goldman J.D.
        • Demple B.
        • et al.
        Role of the acrAB locus in organic solvent tolerance mediated by expression of marA, soxS, or robA in Escherichia coli.
        J Bacteriol. 1997; 179: 6122-6126
        • Mann C.M.
        • Cox S.D.
        • Markham J.L.
        The outer membrane of Pseudomonas aeruginosa NCYC 6749 contributes to its tolerance of the essential oil of Melaleuca alternifolia (tea tree oil).
        Lett Appl Microbiol. 2000; 30: 294-297
        • Pattnaik S.
        • Rath C.
        • Subramanyam V.R.
        Characterization of resistance to essential oils in a strain of Pseudomonas aeruginosa (VR-6).
        Microbios. 1995; 81: 29-31
        • Ford R.A.
        Fragrance raw materials monographs (tea tree oil).
        Food Chem Toxicol. 1988; 26: 407
        • Buckle J.
        Clinical aromatherapy in nursing.
        Arnold, London1998
        • Hayes A.J.
        • Leach D.N.
        • Markham J.L.
        In vitro cytotoxicity of Australian tea tree oil using human cell lines.
        J Essential Oil Res. 1997; 9: 575-582
        • de Groot A.C.
        • Weyland J.W.
        Systemic contact dermatitis from tea tree oil.
        Contact Dermatitis. 1992; 27: 279-280
        • Selvaag E.
        • Holm J.-O.
        • Thune P.
        Allergic contact dermatitis in an aroma therapist with multiple sensitizations to essential oils.
        Contact Dermatitis. 1995; 33: 354-355
        • Selvaag E.
        • Eriksen B.
        • Thune P.
        Contact allergy to tea tree oil and cross-sensitization to colophony.
        Contact Dermatitis. 1994; 31: 124-125
        • Villan D.
        • Knight M.J.
        • Hansen S.R.
        • et al.
        Toxicity of Melaleuca oil and related essential oils applied topically on dogs and cats.
        Vet Hum Toxicol. 1994; 36: 139-142
        • Apted J.H.
        Contact dermatitis associated with the use of tea tree oil.
        Australas J Dermatol. 1991; 32: 177
        • Varma S.
        • Blackford S.
        • Statham B.N.
        • et al.
        Combined contact allergy to tea tree oil and lavender oil complicating chronic vulvovaginitis.
        Contact Dermatitis. 2000; 42: 309-310
        • Bhushan M.
        • Beck M.H.
        Allergic contact dermatitis from tea tree oil in a wart paint.
        Contact Dermatitis. 1997; 36: 117-118
        • Del Beccaro M.A.
        Melaleuca oil poisoning in a 17-month old.
        Vet Hum Toxicol. 1995; 37: 557-558
        • Jacobs M.R.
        • Hornfeldt M.S.
        Melaleuca oil poisoning.
        Clin Toxicol. 1994; 32: 461-464
        • Elliot C.
        Tea tree oil poisoning.
        Med J Aust. 1993; 159: 830-831
        • Seawright A.
        Comment: Tea tree oil poisoning.
        Med J Aust. 1993; 159: 831
        • Zhang S.Y.
        • Robertson D.
        A study of tea tree oil ototoxicity.
        Audiol Neuro-Otol. 2000; 5: 64-68
        • Vilaplana J.
        • Romaguera C.
        Allergic contact dermatitis due to eucalyptol in an anti-inflammatory cream.
        Contact Dermatitis. 2000; 43: 118
        • Knight T.E.
        • Hausen B.M.
        Melaleuca oil (tea tree oil) dermatitis.
        J Am Acad Dermatol. 1994; 30: 423-427
        • Perret C.M.
        • Evans A.V.
        • Russell-Jones R.
        Tea tree oil dermatitis associated with linear IgA disease.
        Clin Exp Dermatol. 2002; 28: 167-170
        • Dharmagunawardena B.
        • Takwale A.
        • Sanders K.J.
        • et al.
        Gas chromatography: an investigative tool in multiple allergies to essential oils.
        Contact Dermatitis. 2002; 47: 288-292
        • Brenan J.A.
        • Dennerstein G.J.
        • Sfameni S.F.
        • et al.
        Evaluation of patch testing in patients with chronic vulvar symptoms.
        Australas J Dermatol. 1996; 37: 40-43
        • Rubel D.M.
        • Freeman S.
        • Southwell I.A.
        Tea tree oil allergy: what is the offending agent? Report of three cases of tea tree oil allergy and review of the literature.
        Australas J Dermatol. 1998; 39: 244-247
        • Southwell I.
        • Freeman S.
        • Rubel D.
        Skin irritancy of tea tree oil.
        J Essential Oils Res. 1997; 9: 47-52
        • Fritz T.M.
        • Burg G.
        • Krasovec M.
        Allergic contact dermatitis to cosmetics containing Melaleuca alternifolia (tea tree oil).
        Ann Dermatol Venereol. 2001; 128: 123-126
      2. Sherry E, Warnke PH. Alternative for MRSA and tuberculosis (TB): eucalyptus and tea-tree oils as new topical antibacterials (poster). Paper presented at annual meetings of American Academy of Orthopaedic Surgeons, Dallas (TX), February 13-17, 2002.

        • Soderberg T.A.
        • Johansson A.
        • Gref R.
        Toxic effects of some conifer resin acids and tea tree oil on human epithelial and fibroblast cells.
        Toxicology. 1996; 107: 99-109
        • Hausen B.M.
        • Reichling J.
        • Harkenthal M.
        Degradation products of monoterpenes are the sensitizing agents in tea tree oil.
        Am J Contact Dermatol. 1999; 10: 68-77
        • Greig J.
        • Thoo S.L.
        • Carson C.F.
        • et al.
        Allergic contact dermatitis following use of a tea tree oil hand-wash not due to tea tree oil.
        Contact Dermatitis. 1999; 41: 354-355
        • Bartek M.J.
        • LaBudde J.A.
        • Maibach H.I.
        Skin permeability in vivo: comparison in rat, rabbit, pig and man.
        J Invest Dermatol. 1972; 58: 114-123
        • Ceschel G.C.
        • Maffei P.
        • Moretti M.D.L.
        • et al.
        In vitro permeation through porcine buccal mucosa of Salvia desoleana Atzei & Picci essential oil from topical formulations.
        Int J Pharm. 2000; 195: 171-177
        • Sherry E.
        • Boeck H.
        • Warnke P.
        Topical application of a new formulation of eucalyptus oil phytochemical clears methicillin-resistant Staphylococcus aureus infection.
        Am J Infect Control. 2001; 29: 346
        • Sherry E.
        • Sivananthan S.
        • Warnke P.H.
        • Eslick G.D.
        Topical phytochemicals used to salvage the gangrenous lower limbs of type 1 diabetic patients.
        Diabetes Res Clin Pract. 2003; 62: 65-66
        • Kerr J.
        Research project: using essential oils in wound care for the elderly.
        Aromatherapy Today. 2002; 23: 14-19
        • Hartman D.
        • Coetzee J.C.
        Two U.S. practitioners' experience of using essential oils for wound care.
        J Wound Care. 2002; 11: 317-320
        • Martin K.
        • Ernst E.
        Herbal medicines for treatment of bacterial infections: a review of controlled clinical trials.
        J Antimicrob Chemother. 2003; 51: 241-246
        • Caelli M.
        • Porteous J.
        • Carson C.F.
        • et al.
        Tea tree oil as an alternative topical decolonization agent for methicillin-resistant Staphylococcus aureus.
        J Hosp Infect. 2000; 46: 236-237
        • Schuster B.G.
        Demonstrating the validity of natural products as anti-infective drugs.
        J Alternative Complementary Med. 2001; 7: 73-82