Abstract
Aim: Candida, an opportunistic organism is one of the commonest causes of hospital acquired infections among fungi. Currently available antifungal drugs have numerous adverse effects and drug-drug interactions (DDIs) along with increase in resistance over the time. Therefore, it is highly emergent to consider alternative treatments for candidal infections, having fewer adverse effects and is cost-effective. The current in-vitro study is undertaken to assess and compare the antifungal effects of the herbs, Berberis aristata (B. aristata, Darehald/Darhald) and Punica granatum (P. granatum, Pomegranate) with fluconazole and voriconazole, based on culture and sensitivity of candidal isolates. Materials and Methods: Ethanolic extracts of herbs (Berberis aristata and Punica granatum) and concentrations were formulated as per standard procedure. 130 samples were obtained for the study from in and out patients reported in clinical subsets of Ziauddin Hospital, Karachi from March to May, 2018. Samples were collected and grown according to the standard procedures like, wet mount test and gram’s staining. Species were identified by CHROM agar candida and API 20 C AUX methods. Sensitivity tests were performed by Kirby Bauer’s disc diffusion method according to CLSI guide lines M-44 A2, 2009. Data analysis was done by one-way ANOVA to compare the antifungal activities of drugs and herbs. Results: Mean inhibitory zones of herbs, B. aristata and P. granatum were highly significant against clinical candidal isolates with respective p-values of 0.00 and 0.02. Both of the herbs, B. aristata and P. granatum were found to be more sensitive, 98.5% and 97.7% respectively in comparison to fluconazole showing 42.3% and voriconazole showing 29.2% sensitivity against candidal isolates. The most resistant candidal specie was C. tropicalis that showed resistance against both fluconazole and voriconazole, contrary to that, this specie was highly sensitive to both of the herbs, showing sensitivity of 100% respective for Darehald and Pomegranate. Conclusion: In comparison to azoles: Culture sensitivity of both herbs (B. aristata and P. granatum) displayed more sensitivity against candidal isolates of patients having non-invasive and invasive candidiasis. These herbs can be considered as substitute or alternative antifungal agents to the conventional antifungal therapy, particularly in cases of treating candidemia patients, which is a life threating condition.
Highlights
The use of herbs in folk medicine has been practiced by humans since ancient times
Materials and Methods: Ethanolic extracts of herbs (Berberis aristata and Punica granatum) and concentrations were formulated as per standard procedure. 130 samples were obtained for the study from in and out patients reported in clinical subsets of Ziauddin Hospital, Karachi from March to May, 2018
Data Analysis: The numerical data of herbs (B. aristata and P. granatum) and azoles were observed and compared by applying one-way analysis of variance (ANOVA) test through a statistical software programanalysis, SPSS 21. 95% confidence interval was taken with p-value less than 0.05 was considered to be significant
Summary
The use of herbs in folk medicine has been practiced by humans since ancient times. The traditional herbal therapy is considered as a “shotgun approach” because of multiple constituents of a herb’s extract, having many therapeutic mechanisms of actions which result in greater therapeutic activity against various diseases [1]. Candidiasis is one of the common opportunistic organisms related to yeast family [6]. The rising resistance to antifungals and cross resistance among its azole class of drugs is a big threat which shows variation topographically [13] [14]. These ground realities are sufficient for the motivation of researchers to consider and evaluate new antifungal drugs or alternative agents for the treatment of candidal infections, showing promising results with better efficacy, lower resistance, fewer adverse effects and affordability of the patients [15]
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