Nathania Nathania ¹ Muhammad T. Hidayat ² Reny I'Tishom ^3*

• ¹ Faculty of Medicine, Airlangga University, Surabaya, Indonesia
• ² Graduate School of Natural Science and Technology, Okayama University, Okayama, Okayama, Japan
• ³ Department of Biomedical Science, Airlangga University, Surabaya, Indonesia

The emergence of antibiotic-resistant Methicillin-Resistant Staphylococcus aureus (MRSA) results from bacterial mutations and misuse of antibiotics. Efflux pumps, like norA and mecA genes, contribute to MRSA's multidrug resistance (MDR). Exploring alternative treatments with target to these specific gene using plant-derived agents like Moringa oleifera leaves extract holds potential in combatting MRSA.This research involved the extraction of Moringa oleifera using maceration, microwave, and Soxhlet methods with various solvents. Confirmation test identification included inhibition zone tests and MIC determination. RT-qPCR was performed using FastKing One Step RT-qPCR with RNA isolation utilizing the RNAsimple Total RNA Kit. The analysis included examination of amplification and melting curves, CT values, and generation of standard curves using associated software. While relative expression of norA and mecA genes were determined using LightCycler96.Moringa had significant antimicrobial inhibitory activity, evidenced by the combination group of methanol extract and amoxicillin, averaging in 21.76mm, and MIC of 19.375mm. RT-qPCR analysis indicated the potential of Moringa oleifera against MRSA resistance. The investigation evaluated the antimicrobial efficacy of Moringa oleifera extracts against MRSA, with ethanol yielding the highest efficacy in the extraction process (72.3%), methanol (41.4%), and ethyl acetate (10.4%). MRSA susceptibility testing confirmed its resistance to multiple antibiotics (cefixime and amoxicilin). Combined treatment with amoxicillin and methanol extract notably reduced mecA and norA gene expression, suggesting promise in combating MRSA resistance.This study highlights the significant antimicrobial potential of Moringa oleifera when combined with amoxicillin against Methicillin-Resistant Staphylococcus aureus (MRSA).Notably, this combination reduced the expression of key resistance genes, mecA and norA, enhancing antibiotic efficacy. With ethanol extract showing the highest efficacy (72.3%), these findings underscore the role of Moringa oleifera in improving antibiotic treatments and combating antibiotic resistance. This could lead to new treatment strategies that integrate natural compounds with traditional antibiotics to effectively manage resistant bacterial infections.