Combination Activity of Standard Antituberculosis Drugs and Extracts of Medicinal Plants Commonly Used in Traditional Treatment of Tuberculosis in Uganda

Introduction: Resistance to antituberculosis drugs and adverse drug reactions remain the leading causes of tuberculosis therapeutic failure globally. Despite the increasing acceptance of medicinal plant use in combination with conventional antituberculosis drugs in treatment of tuberculosis (TB) in Uganda, there is paucity of knowledge on their combination effect. Aim: This research aimed to determine combination activity of standard antituberculosis drugs with extracts of Zanthoxylum leprieurii Guill. & Perr. and Rubia cordifolia L., the two common antituberculosis medicinal plants in Uganda, against pansensitive (H37Rv) and multi-drug resistant (MDR) Mycobacterium tuberculosis strains. Materials and Methods: Two reference MTB strains (H37Rv and MDR strain) were inoculated on Middlebrook 7H11 medium containing a combination of standard antituberculosis drugs and methanol extracts of Z. leprieurii and R. cordifolia at varying concentrations. The number of colonies on the plates was observed and counted weekly for up to 8 weeks. In vitro combination activity was determined using proportion method. Mean percentage inhibition was calculated for the reduction of number of colonies on drug-extract combination medium in relation to drug-extract-free control medium. Results: Drug-extract combinations showed good combination activity against Mycobacterium tuberculosis strains when compared with individual standard anti-TB drugs. This was more exhibited against MDR strain. There was however a reduction in percentage inhibition when extracts were combined with ethambutol and streptomycin against H37Rv strain. Conclusions: Zanthoxylum leprieurii and Rubia cordifolia in combination with standard anti-TB drugs exhibited increased in vitro activity against Mycobacterium tuberculosis, especially MDR-TB strain. This justifies the local use of these plants in traditional treatment of tuberculosis especially in resistant cases in Uganda.

Anti-Mycobacterial Activity of Medicinal Plant Extracts Used in the Treatment of Tuberculosis by Traditional Medicine Practitioners in Uganda

Tuberculosis (TB) remains a public health challenge and one of the leading causes of death worldwide. TB is preventable and curable. However, treatment of tuberculosis has continued to be difficult as a result of rapid increase of multidrug and extensively drug resistant strains of Mycobacterium tuberculosis. Medicinal plants have for centuries been traditionally used in treatment of tuberculosis and similar ailments. They possess antimicrobial properties which render them a new hope as a source of novel bioactive leads in the development of antimycobacterial agents. In this study, 2 plant species commonly used traditionally in Uganda for treatment of tuberculosis, Zanthoxylum leprieurii and Rubia cordifolia were screened for in vitro antimycobacterial activity against Mycobacterium tuberculosis strains;pan sensitive MTB H37Rv, Rifampicin resistant TMC 331 strain and two wild strains (one rifampicin resistant and another one rifampicin susceptible). Antimycobacterial activity of aqueous, ethanolic and methanolic plant extracts was determined using Resazurin Microtiter Assay (REMA). Both plant extracts exhibited significant in vitro antimycobacterial activity against all strains of Mycobacterium tuberculosis. Minimum inhibitory concentrations (MIC) of methanolic crude extracts of both plants ranged from 23.4 μg/mL to 187.5 μg/mL. Comparatively, methanol extracts of both plants possessed superior antimycobacterial activity against all Mycobacterium tuberculosis strains. Our findings indicated that both plants exhibited activity against susceptible and resistant strains of Mycobacterium tuberculosis. While antimycobacterial activity of Z. leprieurii confirms results from previous studies, activity of the extracts of R. cordifolia is reported for the first time in East Africa. Further studies aimed at determining the effects of combination of these plant extracts and standard anti-TB drugs should be carried out.

Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants:The case of Artemisia vulgaris L.substituted for Artemisia annua L.in Western Uganda

Background:Different parts of Artemisia vulgaris L.(A.vulgaris)are ethno-medicinally used as an emmenagogue and for the treatment of ailments such as malaria fever,ulcers,and cancer.However,anecdotal evidence shows that the plant is often substituted for Artemisia annua L.(A.annua)by herbalists in Western Uganda due to similarities in their morphology.Misidentification of medicinal plants and mislabelling of herbal products have been incriminated in toxicity and adverse health outcomes in traditional medicine practise.Because safety continues to be a major issue with the use of herbal remedies,it becomes imperative therefore that medicinal plants should be correctly identified.Methods:This study focused on investigating the macroscopic,microscopic,physicochemical characteristics and phytochemical composition of A.vulgaris leaves compared to A.annua to ease its correct identification.Results:The results showed that there are some colour differences between the leaves of the two species,with a close arrangement of microscopic features but different leaf constants.The leaves of the two Artemisia species had similar tastes,but their shapes and colours(greenish-yellow for A.annua and dark green for A.vulgaris)can be used by the local community to distinguish between them.The artemisinin content was higher in A.vulgaris leaves(1.72%)than in A.annua(1.43%),but the reverse was observed for the total flavonoid content.Conclusion:This observation could justify the change in the use of A.vulgaris by the indigenous community in western Uganda.Further studies should consider the pharmacognostic comparison of A.annua with other species in the genus Artemisia and the use of molecular techniques such as DNA barcoding.