Abstract
IntroductionThe use of herbal medicine is on the rise worldwide, and safety issues associated with herbal medicines may have an exacerbated impact in elderly because this population has an increased susceptibility and sensitivity to health complications due to the aging process.MethodsThis cross-sectional study was carried out at a primary health care unit in the city of Macapa, Brazil. The herbal medicines used and the sociodemographic characteristics of 123 voluntarily consenting participants were collected using a structured questionnaire. A total of 132 herbal medicines with oral or topical administration were donated by the elderly for microbial analysis before consumption, and 18 water samples used in the preparation of homemade herbal medicines were collected. Bacterial and fungal counts and identification of bacterial pathogens (Escherichia coli, Salmonella spp., Pseudomonas aeruginosa and Staphylococcus aureus) were performed according to the regulations of the Brazilian Pharmacopoeia and World Health Organization. Water analysis for the detection of coliforms and E. coli was carried out using Colilert® according to the manufacturer’s instructions and the techniques established by Standard Methods.ResultsOf the study participants, 78.8% were women. Bacterial growth was observed in samples from 51.5% of study and 35.6% had fungal growth. A total of 31.8% of the herbal medicine samples exceeded the safety limits (CFU/g ≤ 105), including 16.7% of the homemade herbal medicines and 15.1% of the commercial herbal medicines. It was also found that 31.0% of the samples exceeded the safety limit for fungal growth. The microorganisms most commonly isolated from the herbal medicines were S. aureus (49.2%), followed by Salmonella spp. (34.8%), E. coli (25.8%), and P. aeruginosa (14.4%). Of water samples analyzed, 77.8% were positive for total coliforms (1 ml) and in 66.7% water samples E. coli was detected (1 ml), making them unfit for consumption.ConclusionsThe use of homemade and commercial herbal medicines is a major risk to the health of elderly who use these therapies due to the lack of microbial quality standards. We observed levels of viable bacteria and fungi that were above safety limits; in addition, we were able to isolate pathogenic bacteria from these herbal medicines.
Highlights
The use of herbal medicine is on the rise worldwide, and safety issues associated with herbal medicines may have an exacerbated impact in elderly because this population has an increased susceptibility and sensitivity to health complications due to the aging process
The present study evaluated the microbial quality of herbal medicines and of water used in the preparation of homemade herbal medicines consumed by the elderly population in the Brazilian Amazon (Macapa, Amapa State)
This study demonstrated the presence of aerobic bacteria and fungi above the acceptable limits as well as the presence of pathogenic bacteria in samples of herbal medicines used by elderly individuals in the Brazilian Amazon region
Summary
The use of herbal medicine is on the rise worldwide, and safety issues associated with herbal medicines may have an exacerbated impact in elderly because this population has an increased susceptibility and sensitivity to health complications due to the aging process. It is estimated that approximately 80% of the population in developing countries uses traditional herbal medicines as part of their primary health care [1, 2]. This finding highlights the importance of research to support the development of traditional herbal medicine practices that provide appropriate, safe, and effective treatments [2,3,4]. Because of gradual devaluation of the knowledge associated with traditional health care-related practices [7], health surveys conducted in several countries have demonstrated the use of herbal medicines as a mainstream practice among elderly people compared with that among young adults [8]. According to the World Health Organization (WHO) [9], the definition of “elderly people” is established according to the socioeconomic level of each nation, with elderly individuals defined as being 60 years of age or greater in developing countries, while in developed countries, the age limit extends to 65 years
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