Indications For Antibiotics Research Articles

Antibiotic Use Awareness and Practices in the Indian Community During Later Stages of COVID-19 Pandemic: A Cross-Sectional Survey

Background: An increased overuse of antibiotics coupled with dearth of newer alternatives has worsened antibiotic resistance in LMIC’s like India. The prescription of antibiotics for symptoms similar to COVID-19 infection has aggravated the problem of antibiotic overuse, further worsening antibiotic resistance. This study aims at understanding not only the extent of overuse, but also the social patterns and causes of over-prescription or self medication of antibiotics in India. Methods: A cross-sectional survey of the knowledge, attitude and practices on antibiotic use was conducted from September to October, 2022, using a Google form questionnaire. A virtual snowball technique was used to recruit respondents. Results: A total of 309 responses were received (56% female and 44% male). 59.5% of the respondents were between 15 to 30 years. Surprisingly, in spite of a majority of respondents (around 70%) having a health sciences background, 67.8% of respondents falsely believe that antibiotics speed up recovery from most coughs and colds. 94.8% of respondents had used antibiotics in the last one year. 17.2% of respondents had taken antibiotics without the prescription of a doctor. The most common antibiotic used on prescription and self-medication was Azithromycin. Only 20.7% of respondents took antibiotics on suspicion of having COVID-19, with the most common one being Azithromycin. Conclusion: The study highlights that a greater knowledge on antibiotic use does not necessitate better attitude towards their cautious and rational use. The use of antibiotics for self-limiting indications like cough, cold and sore throat needs to be restricted through stricter regulations.

Antibiotic Use Awareness and Practices in the Indian Community During Later Stages of COVID-19 Pandemic: A Cross-Sectional Survey

BACKGROUND: Irrational prescription of, and self medication with antibiotics is a rampant problem in LMIC'S like India. The prescription of antibiotics for symptoms similar to Covid-19 infection has aggravated the problem of antibiotic overuse, further worsening antimicrobial resistance. This study aims at understanding not only the extent of overuse, but also the social patterns and causes of overprescription or self medication of antibiotics in India. METHODS: A cross-sectional survey of the knowledge, attitude and practices on antibiotic use was conducted from September to October, 2022, using a Google form questionnaire. A virtual snowball technique was used to recruit respondents. RESULTS: A total of 309 responses were received (56% female and 44% male). 59.5% of the respondents were between 15 to 30 years. Surprisingly, inspite of a majority of respondents (around 70%) having a health sciences background, 67.8% of respondents falsely believe that antibiotics speed up recovery from most coughs and colds. 94.8% of respondents had used antibiotics in the last one year.17.2% of respondents had taken antibiotics without the prescription of a doctor. The most common antibiotic used on prescription and self medication was Azithromycin. Only 20.7% of respondents took antibiotics on suspicion of having Covid-19, with the most common one being Azithromycin. CONCLUSION: The study brings to light trends in the awareness and usage of antibiotics with greater emphasis on the Indian medical community. The findings of this study can be used to formulate a more effective Antimicrobial Stewardship Programs to curb antibiotic overuse. The use of antibiotics for self-limiting indications like cough, cold and sore throat needs to be restricted through stricter regulations. The study highlights that a greater knowledge on antibiotic use does not necessitate better attitude towards their cautious and rational use, nor does it guarantee a supportive attitude towards regulations on antibiotic dispensing. In spite of it's significant cardiovascular adverse drug reactions, Azithromycin was found to be the most commonly used antibiotic in our study. Relatively lower rate of self-medication with antibiotics was seen in our study, which might be due to a greater percentage of respondents with a healthcare background, thus exhibiting positive behavior practices on antibiotic use.

Research and market structure: Evidence from an antibiotic-resistant pathogenic outbreak

We provide causal evidence that upstream research shocks impact unconnected downstream product markets. Focusing on the Indian pharmaceutical market, we use a natural experiment involving a publication that identified a pathogenic outbreak involving a carbapenem antibiotic resistant superbug. Consistent with theory, we find that this upstream research shock caused multinational firms selling carbapenem antibiotics in India to reduce their downstream market exposure. Rational antibiotic stewardship implies that we should observe a similar response by domestic Indian firms. Surprisingly, we observe the opposite, domestic Indian firms filled the void in the market left by multinational firms. We confirm this aggregate finding with prescription level data; Indian physicians prescribed fewer focal multinational products relative to domestic firm products. Results are robust to alternate control groups and placebo testing. Implications for antibiotic resistance, global health policy and innovation policy are discussed.

Systemic antibiotic sales and WHO recommendations, India.

ObjectiveTo analyse sales of fixed-dose combination and single antibiotics in India in relation to World Health Organization (WHO) recommendations and national regulatory efforts to control antibiotic sales.MethodsWe extracted data on sales volumes of systemic antibiotics in India from a market research company sales database. We compared the market share of antibiotic sales in 2020 by WHO AWaRe (Access, Watch and Reserve) category and for those under additional national regulatory controls. We also analysed sales of fixed-dose combinations that were: formally approved for marketing or had a no-objection certificate; on the national essential medicines list; and on the WHO list of not-recommended antibiotics.FindingsThere were 78 single and 112 fixed-dose combination antibiotics marketed in India, accounting for 7.6 and 4.5 billion standard units of total sales, respectively. Access, Watch and Reserve antibiotics comprised 5.8, 5.6 and 0.1 billion standard units of total market sales, respectively. All additionally controlled antibiotics were Watch and Reserve antibiotics (23.6%; 2.9 billion standard units of total sales). Fixed-dose combinations on the WHO not-recommended list were marketed in 229 formulations, with 114 formulations (49.8%) having no record of formal approval or no-objection certificate. While there were no not-recommended fixed-dose combinations on the national list of essential medicines, 13 of the top-20 selling antibiotic fixed-dose combinations were WHO not-recommended.ConclusionThe sale of Watch group drugs, and antibiotics banned or not approved, needs active investigation and enforcement in India. The evidence base underpinning formal approvals and no-objection certificates for not-recommended fixed-dose combinations should be audited.

Country data on AMR in India in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome.

BackgroundAntimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action.ObjectivesTo review the current situation with respect to AMR in India and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize further rises in AMR and to improve patient outcomes.MethodsNational AMR initiatives, antibiotic use and prescribing in India, and availability of susceptibility data, in particular for the key community-acquired respiratory tract infection (CA-RTI) pathogens (Streptococcus pneumoniae and Haemophilus influenzae) were identified. National and international antibiotic prescribing guidelines for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) commonly used locally were also reviewed, plus local antibiotic availability. Insights from a local clinician and clinical microbiologist were sought to contextualize this information.ConclusionsMany initiatives have been launched since AMR was recognized as a national priority and organizations such as the Indian Academy of Paediatrics and the Global Antibiotic Resistance Partnership have worked to build awareness. The Indian Ministry of Health and Family Welfare published a 5 year national action plan on AMR. However, the burden of infectious disease and consumption of antibiotics in India is high. There have been national surveillance studies generating local data along with international studies such as Survey of Antibiotic Resistance (SOAR) and Antimicrobial Testing Leadership and Surveillance (ATLAS). For common RTIs, clinicians use a range of international and national guidelines. However, a more standardized inclusive approach to developing local guidelines, using up-to-date local surveillance data from community-acquired infections, could make guidelines more locally relevant. This would encourage more appropriate antibiotic prescribing and improve adherence. This would, in turn, potentially limit AMR development and improve patient outcomes.

Consumption of systemic antibiotics in India in 2019.

Inappropriate use of antibiotics is a significant driver of antibiotic resistance in India. Largely unrestricted over-the-counter sales of most antibiotics, manufacturing and marketing of many fixed-dose combinations (FDC) and overlap in regulatory powers between national and state-level agencies complicate antibiotics availability, sales, and consumption in the country. We analyzed cross-sectional data from PharmaTrac, a nationally representative private-sector drug sales dataset gathered from a panel of 9000 stockists across India. We used the AWaRe (Access, Watch, Reserve) classification and the defined daily dose (DDD) metrics to calculate the per capita private-sector consumption of systemic antibiotics across different categories: FDCs vs single formulations; approved vs unapproved; and listed vs not listed in the national list of essential medicines (NLEM). The total DDDs consumed in 2019 was 5071 million (10.4 DDD/1000/day). Watch contributed 54.9% (2783 million) DDDs, while Access contributed 27.0% (1370 million). Formulations listed in the NLEM contributed 49.0% (2486 million DDDs); FDCs contributed 34.0% (1722 million), and unapproved formulations contributed 47.1% (2408 million DDDs). Watch antibiotics constituted 72.7% (1750 million DDDs) of unapproved products and combinations discouraged by the WHO constituted 48.7% (836 million DDDs) of FDCs. Although the per-capita private-sector consumption rate of antibiotics in India is relatively low compared to many countries, India consumes a large volume of broad-spectrum antibiotics that should ideally be used sparingly. This, together with significant share of FDCs from formulations outside NLEM and a large volume of antibiotics not approved by the central drug regulators, call for significant policy and regulatory reform. Not applicable.

Sale of antibiotics without prescription in stand-alone pharmacies in Tamil Nadu.

Non-prescription sale of antibiotics is one of the major causes for increased consumption of antibiotics which facilitates the emergence of drug resistance. Over-the-counter sale of antibiotics in India, without prescription and often at partial doses, is quite common even though the practice is not legal. (1) To interview pharmacists about the sale of over-the-counter medication, and prescription drugs sold without a prescription, in particular; (2) to obtain an understanding of the reasons for such sale from the perspective of the pharmacist. Pharmacists were interviewed with the help of a pre-validated questionnaire in 15 stand-alone pharmacies in a metropolitan city and a tier-2 city in Tamil Nadu. Major points of interest were characteristics of customers requesting antibiotics without a valid prescription, common diseases for which they were sold without prescription, whether patients asked for antibiotics by name or as treatment for their symptoms, and reasons for such requests. Pharmacists readily admitted to selling prescription drugs, including antibiotics without a valid prescription. While they know of antibiotic resistance, not a single pharmacist interviewed by us knew of the causes of antibiotic resistance. The intervention listed in the National Action Plan on Antimicrobial Resistance to develop awareness campaigns targeted at dispensers regarding existing rules and appropriate use of antimicrobials and mandatory training programs on optimal antimicrobial use must be implemented immediately.

Disparity in socio-economic status explains the pattern of self-medication of antibiotics in India: understanding from game-theoretic perspective.

The emergence of antimicrobial resistance has raised great concern for public health in many lower-income countries including India. Socio-economic determinants like poverty, health expenditure and awareness accelerate this emergence by influencing individuals' attitudes and healthcare practices such as self-medication. This self-medication practice is highly prevalent in many countries, where antibiotics are available without prescriptions. Thus, complex dynamics of drug- resistance driven by economy, human behaviour, and disease epidemiology poses a serious threat to the community, which has been less emphasized in prior studies. Here, we formulate a game-theoretic model of human choices in self-medication integrating economic growth and disease transmission processes. We show that this adaptive behaviour emerges spontaneously in the population through a self-reinforcing process and continual feedback from the economy, resulting in the emergence of resistance as externalities of human choice under resource constraints situations. We identify that the disparity between social-optimum and individual interest in self-medication is primarily driven by the effectiveness of treatment, health awareness and public health interventions. Frequent multiple-peaks of resistant strains are also observed when individuals imitate others more readily and self-medication is more likely. Our model exemplifies that timely public health intervention for financial risk protection, and antibiotic stewardship policies can improve the epidemiological situation and prevent economic collapse.

A pilot study regarding the consequences of the COVID-19 pandemic on healthcare education in India and the implications

Introduction: The early approaches to prevent the spread of COVID-19 included lockdown and social distancing measures, leading to university closures. These measures forced unparalleled changes to the delivery of healthcare education. Concerns included the preparedness of faculty and students to e-learning as well as the routine availability and funding of equipment and internet bundles. This needed addressing with fully trained healthcare professionals required given rising inappropriate use of antibiotics in India, growing prevalence of non-communicable diseases as well as an increasing number of patients with joint comorbidities. Consequently, there is a need to ascertain the current impact of the pandemic on healthcare student education across India. Materials and Methods: This was a pilot study among 10 purposely selected healthcare educators in both private and public universities. The questionnaire built on published studies. Results: Identified challenges included a lack of familiarity with online education, no bedside teaching, lack of equipment and affordability of internet bundles, poor internet connectivity and postponed examinations. Ways forward included training faculty on e-learning, providing students with loans and other financial support to purchase equipment and internet bundles, establishing COVID-19 prevention protocols and protective equipment, recording lectures and tutorials to make up for lost time and simulated methods to teach clinical aspects. Conclusion: Despite challenges, there was a rapid move to online learning among surveyed universities. Alongside this, courses to address lack of familiarity with e-learning approaches with hybrid teaching approaches here to stay. The next step will be to undertake a wider study and to use the combined findings to provide future guidance.

Assessment of rationality of available fixed dose combinations of antibiotics in India

ABSTRACT Objective India is among the largest consumers of antibiotics. Easy availability and growing sales of Fixed Dose Combinations (FDCs) of antibiotics can worsen Antimicrobial Resistance (AMR). There is lack of comprehensive data on available antibiotic FDC formulations, their dose strengths and adequacy of scientific evidence regarding their efficacy, safety and suitability for human use. In the present work, we aimed at addressing this knowledge gap. Methods Availability of FDCs was ascertained from the Current Index of Medical Specialties (CIMS) [Issue Jan-April 2020]. Customized data abstraction form was used to capture pertinent information for these FDCs. Assessment of rationality was done based on standard parameters. Results More than 90% of the existing FDCs were found to be irrational; with two third of them being unapproved and or banned from use in the country. Conclusions Although the regulatory agency has already taken cognizance of the seriousness of the matter; there is an urgent need to revisit these FDCs to promote prudent antibiotic use. Expert opinion High antibiotic use is associated with antimicrobial resistance; it is imperative that all factors which lead to high antibiotic use are adequately addressed. Easy availability of fixed dose combinations (FDCs) has begun to catch the attention of regulators in developing economies like India leading to a ban of 330 FDCs of which 19% were antibiotic combinations. The continuing presence and increasing sales of these irrational FDCs is a concern for effective antimicrobial stewardship.

Over-the-Counter Sale of Antibiotics in India: A Qualitative Study of Providers' Perspectives across Two States.

India has one of the highest rates of antimicrobial resistance (AMR) worldwide. Despite being prescription drugs, antibiotics are commonly available over-the-counter (OTC) at retail pharmacies. We aimed to gain insight into the OTC sale of antibiotics at retail pharmacies and to elucidate its underlying drivers. We conducted face-to-face, in-depth interviews using convenience sampling with 22 pharmacists and 14 informal dispensers from 36 retail pharmacies across two Indian states (Haryana and Telangana). Thematic analysis revealed that antibiotics were often dispensed OTC for conditions e.g., fever, cough and cold, and acute diarrhea, which are typically viral and self-limiting. Both Access and Watch groups of antibiotics were dispensed for 1–2 days. Respondents had poor knowledge regarding AMR and shifted the blame for OTC practices for antibiotics onto the government, prescribers, informal providers, cross practice by alternative medicine practitioners, and consumer demand. Pharmacists suggested the main drivers for underlying OTC dispensing were commercial interests, poor access to public healthcare, economic and time constraints among consumers, lack of stringent regulations, and scanty inspections. Therefore, a comprehensive strategy which is well aligned with activities under the National Action Plan-AMR, including stewardship efforts targeting pharmacists and evidence-based targeted awareness campaigns for all stakeholders, is required to curb the inappropriate use of antibiotics.

Research and Market Structure: Evidence from a Pathogenic Outbreak

Do upstream research shocks directly and contemporaneously impact related but disconnected downstream product markets? We explore this question using a natural experiment involving the New Delhi Metallo-Beta-Lactamase 1 superbug pathogenic outbreak in India. Using a difference-in-differences strategy, we find that this upstream research shock caused multinational firms selling antibiotics in India to reduce their market exposure. Surprisingly, this void was filled by domestic Indian firms. These results are bolstered by a concurrent decline in multinational prescriptions of focal products by Indian physicians relative to prescriptions for domestic firm products. We present a stylized model building on a Cournot differentiated duopoly model to explain these heterogeneous responses. Results are robust to alternate control groups, including synthetic controls, as well as placebo testing. Implications for health policy and innovation policy are discussed.

A multicentric knowledge-attitude-practice survey in the community about antimicrobial use and resistance in India.

To address the reasons for inappropriate use of antimicrobials, it is important to understand the knowledge, attitude and practices (KAP) of all pertinent stakeholders. This multicentric survey is aimed at understanding the KAP quotients of the community regarding antimicrobial use and antimicrobial resistance (AMR), as such information is lacking in India. A cross-sectional survey was conducted by face-to-face interviews across five centers in India using a validated, field-tested questionnaire incorporating KAP domain questions. Scores were appropriately assigned to the questions. The mean (SD) age of the respondents was 35.2 (12.61) y and 62% had a graduate or higher level of education. The median (IQR) KAP scores were 10 (8-12), 5 (3-5) and 2 (2-3) out of a maximum of 18, 5 and 6, respectively. Higher educational and socioeconomic levels were associated with better attitude scores, but knowledge levels were comparable. Correlations between KAP scores were poor. This study reveals that laypeople have appropriate knowledge and attitude regarding antibiotic use and AMR to some degree but there are important lacunae and practices are often wanting. These issues need to be addressed in sustained public awareness and motivation campaigns to improve the rational use of antibiotics in India.

Science, Pathogenic Outbreak & Market Structure: Evidence from the 2010 NDM-1 Superbug Discovery & Indian Antibiotics Market

It is well documented that as market structure changes, science and technology often tend to respond to those changes. However, is there a causal relationship in the opposite direction, where scientific discovery impacts market structure? We answer this question using the natural experiment of the NDM-1 (New Delhi Metallo-Beta-Lactamase 1) superbug discovery in India, which was reported in August 2010 in Lancet Infectious Diseases. This article demonstrated that the NDM-1 superbug was resistant to the broad spectrum antibiotics, carbapenems, widely recognized as weapons of last resort against infectious bacterial diseases. Using a difference in differences strategy, we find that multinational firms selling antibiotics in India reduced their market shares in sales of carbapenems (our treatment group) compared to narrow-spectrum antibiotics (our control group) immediately after the NDM-1 2010 discovery. We also document a concurrent decline in multinational carbapenem prescriptions by physicians and in channel incentives for drug retailers. In addition, we are able to tease out the role of scientific engagement in driving variation in multinational responses. Our results are robust to pre-trends, alternative controls and while accounting for regional heterogeneity. They are also consistent with synthetic controls. These findings have implications for the information socialization role of science, its impact on resolving managerial uncertainty and in correcting market failures in healthcare for policy makers.

1123. Specificity of Diagnosis Codes and Adequacy of Supportive Documentation for Common Acute Pediatric Infections: Implications for Ambulatory Stewardship

BackgroundAssessing the appropriateness of antibiotic prescribing in ambulatory care generally relies on the accuracy of diagnosis codes, which is uncertain. It is also uncertain if documented history and physical findings support antibiotic indications (AI). We completed a retrospective study of pediatric primary care (PPC) encounters to determine: A) if documented findings supported documented AI; and B) whether diagnosis codes captured documented AI (figure).MethodsWe conducted point-prevalence audits of the 9 PPC clinics in our healthcare system, randomly selecting one weekday per month to review all visits between 9/2017 and 4/2018. We included only encounters with antibiotic prescribing. We reviewed clinician notes, orders, laboratory results, and ICD-10 diagnosis codes. We recorded demographics; visit date/location; AI as documented in notes; history, examination, and laboratory findings; and diagnosis codes. We used national guidelines to determine whether documentation supported AI. We calculated the sensitivity of diagnosis codes using documented AI as the gold standard.ResultsThe sample included 452 encounters. The most common AI were acute otitis media (AOM), pharyngitis, and sinusitis. For AOM, 163 of 168 encounters (97.0%) had an appropriate diagnosis code; for pharyngitis, 127 of 138 (92.0%); and for sinusitis, 68 of 75 (90.7%). For AOM, 160 of 168 encounters (95.2%) had adequate documentation of supportive findings. For sinusitis, 44 of 75 encounters had adequate supporting history and/or examination findings (58.7%). For pharyngitis, while 135 of 139 (97.1%) had a positive streptococcal test, 104 of 139 (74.8%) had history and examination findings to support testing.ConclusionBy chart review, we identified each AI and evaluated whether findings supported those AI. The sensitivity of diagnosis codes for AI ranged from 90.7–97.0% for common conditions; this result can inform the design of ambulatory stewardship programs. Only 74.8% of children treated for pharyngitis and 58.7% of children treated for sinusitis had sufficient supporting documentation. Use of discrete data elements alone (Figure 1) may result in overestimates of the proportion of children for whom antibiotics are appropriate. Further research is needed across healthcare settings. Disclosures All authors: No reported disclosures

Need to improve availability of \u201caccess\u201d group antibiotics and reduce the use of \u201cwatch\u201d group antibiotics in India for optimum use of antibiotics to contain antimicrobial resistance

Need to improve availability of \u201caccess\u201d group antibiotics and reduce the use of \u201cwatch\u201d group antibiotics in India for optimum use of antibiotics to contain antimicrobial resistance

The impact assessment of Scheduel H1 on the sales of over-the-counter antibiotics in India: Evidence from quasi-experimental research design

Purpose: The Schedule H1 of Drugs and Cosmetics Act of Government of India sought to regulate over the counter antibiotic sales in the private market. The objective of this research is to conduct impact evaluation of this policy intervention. Methods & Materials: The intervention is a policy for redcuing over-the-counter sales of antibiotics named Schedule H1 of Drugs and Cosmetics Act of Government of India implemented through/on retail pharmacies on selected antibiotic notified under the new Schedule H1. Monthly data on the antibiotics sold in the private retail market were studied. An ITS model controlling for seasonality and autocorrelation was used to examine the dataset for significant level and trend shifts. Results: Our preliminary analysis suggest a post intervention decrease in the average monthly market share of antibiotics under Schedule H1 by 1.56 percent which was significant (p < 0.05) and a decrease in the trend by 0.041 percent which was not significant (p > 0.05). The ITS model adjusted for seasonality and autocorrelation suggets slight reduction effect size i.e. −1.53% from −1.56% in level change but no change in the trend estimate. Conclusion: The segmented regression analysis of pharmaceutical sales is a robust method for measuring the impact of interventions directed towards medicines utilization. The Schedule H1 intervention was associated with significant decrease in over-the-counter sales of the notified antibiotics intially but the reduction in sales or the impact of the intervention could not be sustained over long term.

Irrational use of antibiotics in India: Time to work together

Antimicrobial resistance is the major public health problem in India due to higher incidence of inappropriate use of antibiotics. India has been reported as a country with one of the number of tropical infectious disease. Recent reports have shown an inappropriate use of antimicrobial agents against these diseases, which has led to increase in microbial resistance.

Non-prescription sale of antibiotics in pharmacies across Puducherry, India

Background: Despite being illegal, non-prescription sales of antibiotics in India continue to be a major contributor to antibiotic abuse, which fosters antibiotic resistance. Methods: Two trained actors simulated symptoms of acute gastroenteritis (AGE) and upper respiratory tract infections (URTI) in 60 pharmacies each randomly selected in the Union Territory of Pondicherry, India. The ease of obtaining antibiotics, any additional enquiries made by the pharmacies, and any additional advise given were noted. Results: Only 33/120 pharmacies (27.5%) declined to dispense antibiotics without prescription; all 33 were attached to a hospital or nursing home. The most frequently dispensed antibiotics for AGE and URTI were ciprofloxacin (41.4%) and coamoxiclav (41.3%) respectively. Out of the 87 pharmacies which dispensed antibiotics without prescription, the presence of additional symptoms and previous drug allergy were enquired by 20 (22.9%) and 9 (10.3%) pharmacies respectively. While over half of the pharmacies gave instructions regarding dose, duration and frequency of antibiotic consumption, none of the pharmacies provided information regarding adverse reaction profile of antibiotics. Non-pharmacological measures for symptomatic improvement were advised by 24/120 pharmacies (20%). Conclusions: Non-prescription sales of antibiotics are unacceptably high in Pondicherry. Stricter implementation of the law and public awareness of the perils of inappropriate antibiotic usage are the need of the hour.

Antimicrobial Activity of Methanolic Extract and Ether Extract of Ageratum conyzoides

Ageratum conyzoides, a weed prevalent in India, is known for its several therapeutic uses to control infections. In the present study we compared the antimicrobial potential of its ether extract and methanolic extract with ciprofloxacin on 294 strains of Gram positive bacteria (GPBs), 575 strains of Gram negative bacteria (GNBs), 15 yeast and 5 mould strains of clinical and nonclinical origin belonging to 49 genera and more than 155 species using disc diffusion assay. The microbial strains in the study were isolated from samples of abiotic (41) and biotic (101) environment, foods (81), clinically sick (441), dead (108) and healthy (75) animals and human beings, and 42 were reference strains. The study revealed that there was no appreciable difference in antimicrobial activity of ether extract (ACEE) or methanolic extract (ACME) of A. conyzoides. A total of 214 (24.1%) strains were sensitive to ACME while of the 697 strains tested for ciprofloxacin 551 (79.1%) were sensitive. Sensitivity to ACME among 294 GPBs (44.9%) was significantly (p<0.0001) higher than among 575 strains of GNBs (12.4%). There was no significant difference among GPBs and GNBs for ciprofloxacin (one of the most commonly used antibiotics in India) sensitivity, but oxidase negative GNBs (385) as well as GPBs (238) were about two times more commonly sensitive to ciprofloxacin than 190 oxidase positive GNBs (p = 0.001) and 56 oxidase positive GPBs (p, 0.03), respectively. For ACME oxidase positive strains had 2.4 times more odds (p < 0.0001) in their favour of being sensitive to ACME (53.4%) than oxidase negative strains (18.6%). The most sensitive strains to ACME belonged to oxidase positive GPBs (62.5%) followed by oxidase negative GPBs (40.8%), oxidase positive GNBs (27.4%) and oxidase negative GNBs (4.9%). All Aeromonas, Alcaligenes, Klebsiella, and Proteus species strains were resistant to ACME irrespective of source of isolation or association with illness. In contrast, majority of the strains of Burkholderia (76.9%), Bacillus (66.7%) and Brucella (53.8%) species were sensitive to ACME. The study revealed that A. conyzoides might be containing useful antimicrobial component(s) more active against oxidase positive potentially pathogenic strains often associated with systemic and deadly infections in animals as well as in humans.