Combination Effect of Antituberculosis Drugs and Ethanolic Extract of Selected Medicinal Plants against Multi-Drug Resistant Mycobacterium tuberculosis Isolates.

Prabasiwi Nur Fauziyah,Dhyan Kusuma Ayuningtyas,Elin Yulinah Sukandar

doi:10.3390/scipharm85010014

Abstract

Adverse drug reaction and resistance to antituberculosis drugs remain the causes of tuberculosis therapeutic failure. This research aimed to find the combination effect of standard antituberculosis drugs with Hibiscus sabdariffa L., Kaempferia galanga L., and Piper crocatum N.E. Br against multi-drug resistant (MDR) Mycobacterium tuberculosis isolates. Two MDR strains (i.e., isoniazid/ethambutol resistant and rifampicin/streptomycin resistant) of M. tuberculosis were inoculated in Löwenstein–Jensen medium containing a combination of standard antituberculosis drugs and ethanolic extracts of H. sabdariffa calyces, K. galanga rhizomes, and P. crocatum leaves using various concentration combinations of drug and extract. The colony numbers were observed for 8 weeks. The effect of the combination was analyzed using the proportion method which was calculated by the mean percentage of inhibition reduction in a number of colonies on drug–extract containing medium compared to extract-free control medium. The results showed that all three plant extracts achieved good combination effects with rifampicin against the rifampicin/streptomycin resistant strain. Antagonistic effects were, however, observed with streptomycin, ethambutol and isoniazid, therefore calling for caution when using these plants in combination with antituberculosis treatment.

Highlights

Tuberculosis (TB) remains one of the deadliest communicable diseases globally, including in Indonesia
The World Health Organization (WHO) estimated that globally in 2013, there were approximately 9 million people suffering from tuberculosis and 1.5 million died from tuberculosis, 360,000 of whom were TB-human immunodeficiency virus (HIV) positive
It was estimated that new cases of multi-drug resistant (MDR)-TB were developed in Indonesia and more than 55% of multi-drug resistant tuberculosis (MDR-TB) patients were not correctly diagnosed or treated [1]

Summary

Introduction

Tuberculosis (TB) remains one of the deadliest communicable diseases globally, including in Indonesia. The World Health Organization (WHO) estimated that globally in 2013, there were approximately 9 million people suffering from tuberculosis and 1.5 million died from tuberculosis, 360,000 of whom were TB-human immunodeficiency virus (HIV) positive. Increasing cases of multi-drug resistant tuberculosis (MDR-TB) and poor achievement in therapeutic goals are the major concerns. The proportion of new MDR-TB cases was 3.5% of all new tuberculosis cases globally and the number of MDR-TB patients increased three-fold in 2013. It was estimated that new cases of MDR-TB were developed in Indonesia and more than 55% of MDR-TB patients were not correctly diagnosed or treated [1]. Many patients did not achieve therapeutic the therapeutic goals due to side effects during therapy and non-compliance with the regimen of therapy [2]

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