Evaluation of Antibacterial Activity and Synergistic Interaction between Punica granatum peels and Synthetic Antibiotics on Multidrug-Resistant Bacteria

Abstract

IntroductionAntibiotic resistance threatens global health, necessitating the development of new antimicrobial medications. Novel drugs can reverse drug resistance and revitalize the antibiotic arsenal. Therefore, this study aimed to evaluate the synergistic antibacterial effect of Punica granatum (P. granatum) extract and antibiotics against multidrug-resistant bacteria (MDR). MethodsPreliminary susceptibility profiling of the antibiotics, the antibacterial activity of the extract, and synergistic interactions between the extract and the three antibiotics were conducted using well diffusion and micro-broth dilution assays with resazurin dye. The inhibition zones (IZs), minimum inhibitory concentrations (MICs), and Fractional Inhibition Concentration Index (FICI) were determined. The data were analyzed using statistical software program (SPSS 26). ResultsThe bacterial isolates exhibited resistance to all antibiotics, except E. coli and P. aeruginosa were sensitive to Ciprofloxacin. P. granatum extract demonstrated an inhibitory effect on all tested bacteria. The FICI values for MDR strains ranged from (0.12 to 0.53), and the best synergistic effect was observed when Augmentin and Ciprofloxacin were combined against these strains. The FICI indices for the combination of P. granatum and Azithromycin ranged from (0.12 to 0.53). ConclusionThis study identified P. granatum extract as a potential adjunctive therapy to antibiotics for the treatment of multidrug-resistant bacteria.