Antimicrobial evaluation of plants used for the treatment of diarrhoea in a rural community in northern Maputaland, KwaZulu-Natal, South Africa

BACKGROUND: Zulu people living in the rural area of Maputaland (KwaZulu-Natal, South Africa) rely heavily on medicinal plants for the treatment of diarrhoea. Abundant availability of medicinal plants in the study area offers low cost health care, but scientific validation is needed in order to lend credibility to the traditional use against many ailments including diarrhoeal infections. With this in mind a study was designed to test the in vitro antimicrobial efficacy of 23 plant species which are used for the treatment of diarrhoea in rural Maputaland. Four 1:1 plant combinations were also evaluated to determine their interactive effects against seven diarrhoea-related bacterial pathogens. METHODS: Minimum inhibitory concentration (MIC) assays were undertaken on dichloromethane-methanol (CH(2)Cl(2): MeOH) and aqueous crude extracts. The following micro-organisms were selected for this study and were tested based on their association with stomach ailments and diarrhoea; Bacillus cereus (ATCC 11778), Enterococcus faecalis (ATCC 29212), Escherichia coli (ATCC 8739), Proteus vulgaris (ATCC 33420), Salmonella typhimurium (ATCC 14028), Shigella flexneri (ATCC 25875) and Staphylococcus aureus (ATCC 12600). The fractional inhibitory concentration index (ΣFIC) was determined for plants traditionally used in combination. RESULTS: Shigella flexneri proved to be the most susceptible pathogen, where the organic extract of Terminalia sericea showed the most prominent noteworthy antibacterial activity (mean MIC value of 0.04 mg/mL). The aqueous extracts generally showed poorer antimicrobial activity with some exceptions i.e. Acacia burkei, Brachylaena transvaalensis against B. cereus and B. transvaalensis against S. flexneri. In the combination studies, synergy was predominant with mean (across all pathogens) ΣFIC values of 0.30 for Acanthospermum glabratum with Krauseola mosambicina; ΣFIC values of 0.46 for A. glabratum with Psidium guajava; ΣFIC values of 0.39 for B. transvaalensis with P. guajava and ΣFIC values of 0.88 (additive) for the combination of B. transvaalensis with Sclerocarya birrea. CONCLUSION: This study provided some insight into the bacterial in vitro efficacies of plants traditionally used to treat diarrhoea by the people of Northern Maputaland. Very little connection was observed between frequency of use and efficacy. Plant combinations demonstrated favourable efficacy with mostly synergistic effects noted, lending some credibility to their use in combination.