Synergetic effect of Azadirachta Indica and Ocimum Tenuiflorum leaves on esbl producing uropathogenic E. Coli in urine samples of children at Khairpur, Sindh, Pakistan

Abstract

Objective: To compare the antibacterial activity between commercial antibiotics versus Azadirachta indica (Neem) and Ocimum tenuiflorum (Tulsi) against clinical isolates of E. coli in urine sample of children.

Methodology: This study was comparative analytical study conducted at pediatric department, Talukas hospitals of district Khairpur (Mir’s), Sindh, from January 2020 to February 2022. Midstream urine samples of children (n=596) were collected from Taluka hospitals of District Khairpur (Mir’s) such as Khairpur, Gambat and Taluka Hospital Kotdiji. All samples were inoculated on different laboratory media and incubated for 24-48 hours. The determination of ESBL producing bacteria were tested by E-test. Double disk synergy method and antibiotic susceptibility test of ESBL producing E. coli isolates was performed by agar gel diffusion method. The extracts of Azadirachta indica (Neem) and Ocimum tenuiflorum (Tulsi) leaves were prepared by rotary evaporator and antibacterial effect of extracts was determined by agar well diffusion method. All data were entered in predesigned proforma.  

Results: Out of 596 urine samples, ESBL producing E. coli 456 (76.1%) were isolated from urine samples of children. The mean age was 9.50±5.48 years (ranged between 2 – 17 years). In this study 254 (42.6%) were male while majority 342 (57.4%) were female. The greater resistance among the E.coli isolates was noted in Aztreonam 160 (35.1%) followed by Ampicillin 129 (28.3%), Amoxicillin/clavulanate 108 (23.7%) and others antibiotics. The observation of Azadirachta indica and Ocimum tenuiflorum extracts revealed the greater antibacterial effects on ESBL producing test isolates at the concentration of 01 to 25 µL/100 mL whereas the synergetic effect of both extracts was greatly observed at 14 µL/100 mL concentration by agar well diffusion method.

Conclusions: Urinary tract infection caused by multidrug resistant E. coli and ESBL producing E. coli was greatly prevailing all age groups of both genders particularly in 13-17 years of children. The antibiotic susceptibility test revealed multidrug resistant while Azadirachta indica and Ocimum tenuiflorum extracts revealed the greater antibacterial effects. These findings are concluded that emergence of MDR strains of ESBL- E. coli could be treated with test extracts as alternate and inexpensive therapy.