IV. 1. PROFILE OF THERAPEUTIC DRUGS...

42

IV. 1. PROFILE OF THERAPEUTIC DRUGS CONSUMPTION

The study performed in the city of Vijayawada observed the

following points in this chapter:-

Type of Prescription.

Different Categories of therapeutic drugs.

Individual therapeutic drug groups.

This study collected about 602 prescriptions from the following

areas:

Public Sector - Government Hospital

Private Sector - Private Hospital

- Retail Pharmacy outlets

TYPE OF PRESCRIPTION

The data was collected according to the questionnaire prepared at

the above said areas, which include prescriptions from public sector

[39.9%] and from private sector [60.1%]. As said above private sector

includes prescriptions from private hospital [32.2%] and from retail

pharmacy outlet [27.9%]. The prescriptions at government hospital

and private hospital are by doctors but at retail pharmacy outlet,

apart from doctor’s prescriptions [13%], self [4.6%] and pharmacist

[10%] prescriptions were also observed [figure.IV.1.a].

43

Figure.IV.1.a: Percentage Distribution of prescriptions at Public and Private Health sectors.

Public sector 39.9%

Private Hospital32.2%

Retail Pharmacy Outlets 27.9%

Private sector60.1%

DISTRIBUTION OF PRESCRIPTIONS

Pharmacist -10%

Self - 4.6%

Doctor - 13%

44

Different occupants were present among the 602 prescriptions from

all three selected areas [table.IV.1.a]. Occupants who followed doctor’s

choice in procuring various categories of drugs were private job

holders [20%], students [22.5%], housewives [17.5%], agricultural

owners [5%], businessmen [5%], educational professionals [2.5%],

senior citizens [10%], daily wagers [15%] and children [up to 12 years]

[2.5%].

Many occupants were also observed to self prescribe and follow

prescriptions by pharmacist. The occupants who followed self

prescriptions were private job holders [35.7%], housewives [14.3%],

educational professionals [7.1%], senior citizens [28.6%] and daily

wagers [14.3%]. The occupants who followed pharmacist prescriptions

account to 6.5% private job holders, 16.1% students, 25.8%

housewives, 3.2%, educational professionals, 6.5% senior citizens,

35.5% daily wagers, 3.2% government employees and 3.2% children

[up to years 12 years]. The mean number of drugs/order per

prescription by physicians at public, private hospital, retail pharmacy

outlet and also self and pharmacist as indicated in the table.2 are

3.33, 5.51, 3.31, 1.86 and 2.24 respectively [table.IV.1.b].

45

Table.IV.1.a: Percentage prevalence by occupation prescribed by different prescribers

OCCUPATION

PRESCRIBERS IN THE STUDY

DOCTORS

[%]

SELF

[%]

PHARMACIST

[%]

Private Job Holders 20 35.7 6.5

Students 22.5 - 16.1

Housewives 17.5 14.3 25.8

Agricultural Farmers 5 - -

Business 5 - -

Medical and Educational Professional 2.5 7.1 3.2

Senior citizens 10 28.6 6.5

Daily wagers 15 14.3 35.5

Government employee - - 3.2

Children [up to 12 years] 2.5 - 3.2

46

Table.IV.1.b: Mean number of drugs prescribed by physicians at public and private sectors and drugs

dispersed on self request and pharmacist prescription at retail pharmacy outlet.

S.NO

Area

[Number] %

No of drugs Mean ± SD

1. Public Health Sector

Government Hospital [Doctor]

[240] 39.9 %

%%%%

800

3.33 ± 0.53

2.

Private Health Sector

Private Hospital [Doctor]

Retail Pharmacy Outlets

Doctor

Pharmacist

Self

[194] 32.2%

[78] 13.0 %

[62] 10.3%

[28] 4.7%

1068

244

150

52

5.51±1.39

3.31±0.81

2.24±1.04

1.86±0.8

47

DIFFERENT CATEGORIES OF THERAPEUTIC DRUGS

The study specifies the rate of choice of drugs prescribed by doctors

at public and private sectors and also rate of self prescription and

prescriptions by pharmacist at the retails pharmacy outlet.

About 2314 drugs have been recorded in the study which included

different therapeutic categories. The different drug categories included

[16.8%] antibiotics, [8.8%] cardiac drugs, [16.6%] analgesics and ant-

pyretic, [6.1%] neurological drugs, [18.5%] gastrointestinal drugs,

[9.6%] respiratory drugs, [2.4%] hormones, [19%] nutrition and

metabolism, [2.2%] others [topical applications, surgical, vaccines,

gynecology drugs,].

Overall study revealed that, gastrointestinal drugs were the highly

prescribed therapeutic drugs followed by nutrition and metabolism,

antibiotics, analgesics and anti-pyretics, cardiac drugs, respiratory

drugs, neurological drugs, hormones and others [topical applications,

vaccines and gynecology drugs].

Prescribed and Dispersed Drugs

From the 2314 drugs, 2112 [91.3%] were prescribed drugs and 202

[8.7%] were dispersed drugs.

Prescribed drugs included antibiotic [15.6%], analgesics and

antipyretic [15.4%], gastrointestinal drugs [17.1%], nutrition and

metabolism [17.6%], cardiac drugs [8.1%], neurological drugs [5.6%],

respiratory drugs [8.9%], hormones [7.5%] and others [4.2%].

[figure.IV.1.b]

48

Figure.IV.1.b: Percentage prevalence of drugs prescribed (Doctors) and dispersed (by Self and Pharmacist) at

Public and Private Sectors. [Prescribed drugs in plain colour and dispersed drugs in shaded colour]

49

Dispersed drugs included antibiotic [4.4%], analgesics and

antipyretic [31.6%], gastrointestinal drugs [15.8%], nutrition and

metabolism [14.0%], cardiac drugs [2.6%], neurological drugs [2.6%],

respiratory drugs [11.4%], hormones [9.6%] and others [4.4%].

[figure.IV.1.b]

Prescribed Drugs

From the 240 prescriptions at public sector [Government hospital]

800 drugs were procured on doctor’s prescription which included

antibiotic [10.3%], analgesics and antipyretic [18%], gastrointestinal

drugs [19.8%], nutrition and metabolism [24%], cardiac drugs

[16.0%], neurological drugs [1.5%], respiratory drugs [5.8%],

hormones [3.0%] and others [1.8%]. [figure.IV.1.c]

From the 272 [Private hospital-194 and retail pharmacy outlet -78]

prescriptions at private sector [private hospital and retail pharmacy

outlet] 1312 [Private hospital-1068 and retail pharmacy outlet -244]

drugs were procured on doctor’s prescription which included

antibiotic [21.7%], analgesics and antipyretic [15.9%], gastrointestinal

drugs [17.9%], nutrition and metabolism [13.5%], cardiac drugs

[10.8%], neurological drugs [9.4%], respiratory drugs [7.4%],

hormones [1.6%] and others [1.8%]. [figure.IV.1.d]

Dispersed drugs

Pharmacist and self-prescriptions are observed at private sector

[Retail pharmacy outlet only]. From the 62 prescriptions 150 drugs

were procured on pharmacist advice which included antibiotic [6.7%],

analgesics and antipyretic [36%], gastrointestinal drugs [18.7%],

50

Figure.IV.1.c: Percentage prevalence of drugs prescribed by physicians at Public sector [Government hospital]

Antibiotics, 10.3%

Analgesic & Antipyretics,

18.0%

Drugs for Gastrointestinal

Disorders,19.8%

Nutrition and metabolism,

24.0%

Cardiac drugs, 16.0%

Drugs for Neurological Disorders,

1.5%

Drugs for Respiratory System, 5.8%

Hormones, 3.0%

Others,1.8%

PUBLIC SECTOR

51

Figure.IV.1.2. d: Percentage prevalence of drugs prescribed by physicians at Private sector.

Antibiotics,21.7%

Analgesics & Antipyretics, 15.9%

Drugs for Gastrointestinal

Disorders, 17.9%

Nutrition and metabolism, 13.5%

Drugs for Cardiac Disorders, 10.8%

Drugs for Neurological Disorders,

9.4%

Drugs for Respiratory Disorders,

7.4%

Hormones,1.6%

Others, 1.8%

PRIVATE SECTOR

52

nutrition and metabolism [12.0%], cardiac drugs [6.7%], neurological

drugs [1.3%], respiratory drugs [16%], hormones [1.3%] and others

[1.3%]. [figure.IV.1.e]

From the 28 prescriptions 52 drugs were procured on self- request

which included analgesics and antipyretic [34.6%], gastrointestinal

drugs [7.7%], nutrition and metabolism [7.7%], cardiac drugs [7.7%],

neurological drugs [7.7%], respiratory drugs [23.1%], hormones [7.7%]

and others [3.8%]. [figure.IV.1.e]

53

Figure.IV.1.e: Percentage prevalence of drugs dispersed on self- request and pharmacist’s choice at Retail

Pharmacy outlet.

34.6

7.7 7.7 7.7 7.7

23.1

7.7

3.8

6.7

36.0

18.7

12.0

6.7

1.3

16.0

1.3 1.3

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

% D

ISTR

IBU

TIO

N

DISPERSED DRUGS

Self Pharmacist

54

INDIVIDUAL THERAPEUTIC DRUGS GROUPS

In this study, different therapeutic drugs were used. Highly

prescribed therapeutic drug categories were analyzed for drug groups

of frequent choice either by doctor or by pharmacist and self.

[table.IV.1.c]

NUTRITON AND METABOLISM

Vitamin B Complex, mineral supplements and iron Preparations

constituted a high proportion of nutritional products at the selected

areas. The prescriptions at government hospital constituted high as

76% Vitamin B complex followed by 21% mineral supplements and

2% iron preparations. The dominant categories of nutritional products

at private sector [prescribed] were 58% Vitamin B-complex followed by

18% mineral supplements and 11% iron preparations. Similarly

nutritional products were also dispersed at private sector [retail

pharmacy outlet] by pharmacist as 55% Vitamin B complex were the

top nutritional products prescribed followed by 45% mineral

supplements. Apart from the top 3 categories, antioxidants and

protein preparations were prescribed at government hospital and

multispecialty hospitals at a low percentage.

GASTROINTESTINAL DRUGS

Under gastrointestinal drugs, H2 blockers, antacids and laxatives

were the top number of drugs prescribed by doctors in the selected

areas. These drugs were also dispersed at private sector [retail

pharmacy outlet] by pharmacist as; 44% of H2 blockers, 31% antacids

55

and 6% laxatives, while physicians at private sector prescribed 76%

H2 blockers followed by 13 % laxatives followed by 5% antacids.

Similarly at government hospital physicians prescribed higher

proportion of 82% H2 blocker followed by 15% antacids and 3 %

laxatives. Anti-diarrhoeals and carminatives were also other groups

which were prescribed at a very low rate.

ANTIBIOTICS

These were categorized into 86.2% Anti-bacterial, 9% anti-

protozoal, 1.8% anti-malarial and anti-fungal, and 0.6% anti-

helminthic and 0.6% anti-viral categories [figure.IV.2.a]. Higher

portion of antibacterials included many different antibiotic classes.

Among them were cephalosporins of 36% followed by 22% quinolones

and 14% penicillin were the top 3 classes of antibiotics prescribed by

physicians at private sector in contrast 44% penicillins and 28%

quinolones were the antibiotic classes dispersed by pharmacist at

private sector [retail pharmacy outlet]. Similarly 30% pencillins were

more frequently prescribed at public sector followed by 24%

quinolones and 3% cephalosporin. Other groups such as

aminoglycosides, tetracyclines, sulphonamides, macrolides and

oxazolinadones were also prescribed. Because of higher frequency of

antibacterials and increasing trends in bacterial resistance has made

to emphasize on detail study on usage of different groups of

antibiotics and bacterial resistance in the selected areas, which is

explained in further chapters.

56

Table.IV.1.c: Percentage distribution of the top 3 drugs sold within

the top 8 therapeutic classes at public (government hospital) and

private sector (private hospital and retail pharmacy outlet).

THERAPEUTIC CATEGORY

Private Sector

Public Sector

Prescribed Dispersed Prescribed

Nutrition and Metabolism

Vitamins

Mineral supplements

Iron preparations

55%

45%

-

58%

18%

11%

76%

21%

2%

Gastrointestinal drugs

H2 Blockers

Antacids

Laxatives

44%

31%

6%

76%

5%

13%

82%

15%

3%

Antibiotics

Quinolones

Penicillins Cephalosporins

28%

44% -

22%

14% 36%

24%

30% 3%

Analgesics/Anti-inflammatory

Antipyretic and analgesics

NSAIDS

Muscle relaxants

75%

56%

8%

88%

13.0%

3%

44%

81.2%

4%

Respiratory drugs

Anti-Allergic

Bronchodilators

Expectorant

37%

27%

22%

26%

37%

26%

61%

30%

9%

Cardiac Drugs

Anti-Hypertensive Anti-Anginal

Diuretics

40% 10%

6.7%

26% 10%

13.3%

22% 8%

5%

Nervous System drugs

Sedatives

Anti-Emetic Anti-convulsants

71%

- 29%

20%

34% 28%

66%

- 17%

Hormone

Hyper & Hypoglycaemic Thyroid Hormone

Cortico Steroids

100% -

-

40% 30%

30%

83% 14%

3%

[Prescribed by doctor and dispersed by pharmacist and on self-request.]

57

ANALGESICS AND ANTI-PYRETICS

Study showed higher proportion of anti-pyretics then NSAID then

muscle relaxants and least topical analgesics. Pharmacist at private

sector [retail pharmacy outlet] dispersed 75% anti-pyretics, 5.6% non-

steroid anti-inflammatory drugs [NSAIDs] and 8% muscle relaxants.

The topical analgesics were prescribed mostly by pharmacists at a

very low proportion. On the other hand physicians at private sector

prescribed 88% antipyretic and analgesics, 13% NSAIDs and 3%

muscle relaxants. At public sector 44% anti-pyretics, 81.2% NSAIDs

and 4% muscle relaxants were prescribed.

RESPIRATORY DRUGS

Anti-allergic, bronchodilators, expectorants constituted a high

proportion of respiratory drugs on prescription at the selected areas.

26% and 61% anti- allergic, 37% and 30% bronchodilators and 26%

and 9% expectorants were prescribed physicians at private sector and

public sector respectively. Pharmacist dispersed 37% anti-allergic,

27% bronchodilators and 22% expectorant. Anti-asthmatic was

another drug of choice under respiratory problems.

CARDIAC DRUGS

Anti-hypertensive, anti-anginal and diuretics were the top 3 drug

categories among the all cardiac drugs. Physicians at private sector

prescribed more of 26% anti-hypertensive then 10% anti-anginal and

13.3% diuretics. Similarly physicians at public sector prescribed high

proportion of 22% anti-hypertensive then 8% anti-anginal and 5%

58

diuretics. 40% anti-hypertensive drugs, 10% anti-anginal and 6.7%

diuretics were the cardiac drugs dispersed by pharmacist. The other

cardiac drug categories prescribed were anti-coagulants, blockers,

peripheral-vasodilators, anti-platelet, coagulant and vasopressin were

prescribed at low percentage.

NERVOUS SYSTEM DRUGS

66% sedatives and 17% anticonvulsants were prescribed at public

sector. In contrast 34% anti-emetic, 28% anti-convulsants and 20%

sedatives were the prescribed drugs by physicians at private sector.

71% sedatives and 29% anti-convulsant were dispersed by

pharmacist. The other drugs prescribed at low frequency under this

category were cerebral activators, anti-depressants, anti-migraine and

peripheral neurotherapy.

HORMONES

Hyper and hypoglycemic, thyroid hormones, corticosteroids were

the categories prescribed. Hyper and hypoglycemic hormones were the

only drugs dispersed at private sector by pharmacist while 40% were

prescribed by physicians at private sector followed by 30% thyroid

hormones and 30% corticosteroids. At public sector 83% hyper and

hypoglycemic drugs, 14% thyroid hormones and 3% corticosteroids

were prescribed.

59

OTHER DRUGS

The other drug categories prescribed at lower frequencies than

hormones were topical applications, surgical, vaccines and gynecology

drugs.

60

IV.2. ANTIBIOTIC CONSUMPTION PROFILE

The outcomes of the study in this chapter were:-

Profile of consumption of antibiotics

Antibiotics usage at the selected areas

Public sector - Government hospital

Private sector - Private hospital

- Retail pharmacy outlet

Cost towards antibiotic therapy

PROFILE OF CONSUMPTION OF ANTIBIOTICS

The total number of prescriptions collected from the selected areas

were 602 among them number of antibiotics prescribed were 332.

These were categorized into 84.2% Anti-bacterial, 9% anti-protozoal,

2.2% antitubercular, 1.7% anti-malarial, 1.7% anti-fungal, and 0.5%

anti-helminthic and 0.5% anti-viral categories. [figure.IV.2.a]

Different occupants who were on antibiotic therapy for different

clinical disorders were observed. The prescribers in the study were

doctors at public [27.6%] and private sector [69.7%], and pharmacists

[2.7%] at private-retail pharmacy outlets [figure.IV.2.b]. occupants

involved in antibiotic therapy were private job holder [public- 4.9%,

private- 10.3%, pharmacist], student [public- 7.3%, private-11.2%,

pharmacist- Nil], housewives (public-34.1%, private-16.8%,

pharmacist-14.3%), agricultural landlords (public-2.4%, private-

16.8%, pharmacist-28.6%) and daily wagers (public -26.8%, private-

4.7%, pharmacist-28.6%). Moreover, pharmacists dispersed

antibiotics to both educated and uneducated citizens and to senior

citizens. [figure.IV.2.c]

61

Figure.IV.2.a: Different types of antibiotics procured.

62

Figure.IV.2.b: Prescribers of antibiotics at public [Government hospital] and private sector [Private hospital and

retail pharmacy outlet]

27.6

69.7

2.7

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Public sector (Doctor) Private sector (Doctor) Private sector (Pharmacist)

% D

istrib

utio

n

Prescribers

PRESCRIBERS OF ANTIBIOTICS

63

Figure.IV.2.c: Percentage distribution of occupant involved in antibiotic therapy.

64

The consumption profile of different categories of antibiotics [only

anti-bacterial] were penicillins [22.3%], quinolones [22.3%],

cephalosporins [21.1%], aminoglycosides [15.1%], tetracyclines [9.0%],

sulphonamides [5.4%], macrolides [2.4%], oxazolinodones [1.8%] and

chloramphenicol [0.6%]. [table.IV.2.a]

Physicians at public sector prescribed high proportion of penicillins

[28.6%] and quinolones [28.5%], sulphonamide [22.9%] followed by

tetracyclines [20.0%]. In contrast to physicians at public sector,

physicians at private sector prescribed high percentage of

cephalosporins [33.3%] to various clinical disorders followed by

quinolones [17.7%], penicillins [17.7%], aminoglycosides [16.7%],

tetracyclines [5.2%], oxazolinodones [5.2%] and macrolides [4.2%],

while pharmacist dispersed penicillins [80.0%] and 20%

chloramphenicol. [table.IV.2.a]

The dosage forms in which the antibiotics were given were

injections, tablets, capsules, syrups or drops. At private sector doctor

prescribed 56.1% tablets, followed by 31.8% injections, 10.6%

capsules and 1.5% in the form of syrups, while pharmacist preferred

60% capsules and 40% tablets. At public sector doctors prescribed

57.6% tablets, 25.9% injections and 15.3 % capsules [table.IV.2.b].

65

Table.IV.2.a: Consumption Profile of Antibiotics at public [Government hospital] and private sector [Private

hospital and retail pharmacy outlet]

ANTIBIOTICS

PRIVATE SECTOR

PUBLIC SECTOR

Prescribed

%

Dispersed

%

Prescribed

%

1. Penicillins [22.3%] 17.7 80.0 28.6

2. Quinolones [22.3% ] 17.7 0.0 28.6

3. Cephalosporins [ 21.1%] 33.3 0.0 0.0

4. Amino glycosides [15.1%] 16.7 0.0 0.0

5. Tetracyclins [9.0%] 5.2 0.0 20.0

6. Sulphonamides [5.4%] 0.0 0.0 22.9

7. Macrolides [2.4% ] 4.2 0.0 0.0

8. Oxazolinodones [1.8%] 5.2 0.0 0.0

9. Chloramphenicol [0.6%] 0.0 20.0 0.0

66

Table.IV.2.b: Dosage forms of antibiotic prescribed at private [private hospital, retail pharmacy] and public

[government hospital] and dispersed by pharmacist at private sector [retail pharmacy outlet]

DOSAGE FORMS OF

ANTIBIOTICS GIVEN PRIVATE SECTOR PUBLIC SECTOR

Prescribed

%

Dispersed

%

Prescribed

%

Injections 31.8 - 25.9

Oral

Capsule

Tablets

10.6

56.1

60.0

40.0

15.3

57.6

Syrup/Drops 1.5 - -

67

ANTIBIOTIC USAGE AT THE SELECTED AREA

Public Sector (Government Hospital)

Quinolones, penicillins, tetracycline and sulphonamides were the

antibacterial categories prescribed at government hospital. The

individual groups prescribed under these categories were

[figure.IV.2.d]:

Among the quinolones ciprofloxacin [14%], norfloxacin [11%] and

ofloxacin [3%] were prescribed.

Under penicillin category, traditional antibiotic such as penicillin G

[3%] and semi- synthetic penicillin, ampicillin [26%] were prescribed.

Tetracycline [3%] and doxycycline [17%] were prescribed among

tetracycline category.

Co- trimoxazole [23%] was the only antibiotic prescribed under

sulphonamides category at public sector.

Private Sector (Private hospital and Retail pharmacy outlet)

Cephalosporins, quinolones penicillins, aminoglycosides,

macrolides, tetracyclines and oxazolidinones were the prescribed

antibiotic at private sector by doctor. The individual groups prescribed

under these categories were [figure.IV.2.e]:

Cephalosporins were the top category, which were prescribed at

high percentage at private sector especially at private hospital. In

these cephalosporins, II and IV generation cephalosporins were

prescribed which included cefuroxime [2%] and cefepime [2%]. High

proportion of III generation cephalosporins of cefotaxime [8%],

cefotaxime+sulbactum [3%], ceftriaxone [1%], ceftriaxone+sulbactum

68

Figure.IV.2.d: Antibiotic consumption at Public Health Centre (Government Hospital)

[Light green- Penicillins, violet- Quinolones, red- tetracyclines, fluorescent green- Sulphonamides]

Ampicillin26%

Penicillin G3%

Ciprofloxacin14%

Norfloxacin11%

Ofloxacin3%

Doxycycline17%

Tetracyclin3%

Cotrimoxazole23%

PUBLIC SECTOR

69

Figure.IV.2.e: Antibiotic consumption at private sector (Private hospital and Retail pharmacy outlet).

[Light green- Penicillins, violet- Quinolones, light blue- Cephalosporins, yellow- Aminoglycosides, red-

tetracyclines, pink- Macrolides and light orange- Oxazolinodones]

Amoxycillin+Clavulanic acid11%

Ampicillin1%

Penicillin1%

Pipericillin+Tazobactum3%

Norfloxacin1%

Ofloxacin12%

Ciprofloxacin2%

Levofloxacin

1%

Cefotaxime8%

Cefotaxime +sulbactum3%

Ceftriaxone1%

Ceftriaxone+sulbactum8%

Cefpodoxime

8%

Cefepime2%

Cefuroxime2%

Cefoperazone+sulbactum3%

Amikacin14%

Gentamycin 2%

Tobramycin1%

Doxycyclin

5%

Teicoplanin2%

Clindamycin2%

linezolid4%

PRIVATE SECTOR

70

[8%], cefpodoxime [8%], cefoperazone+sulbactum [3%] were

prescribed.

Under quinolones ciprofloxacin [2%], norfloxacin [1%], levofloxacin

[1%] and ofloxacin [12%] were prescribed.

In the penicillin category a combination of amoxicillin+ clavulanic

acid [11%] followed by pipericillin+ sulbactum [3%] and ampicillin

[1%] and penicillin [1%].

Another category was aminoglycosides, which included amikacin

[14%], gentamycin [2%] and tobramycin [1%].

Next category is occupied by macrolides which included teicoplanin

[2%] and clindamycin [2%].

In tetracyclines, doxycycline was the only individual antibiotic

prescribed of 5%.

And lastly under oxazolidinones, linezolid [4%] was the individual

antibiotic prescribed.

Dispersed antibiotics

Amoxicillin [60%] and ampicillin [20%] were dispersed by the

pharmacist under penicillin category and chloramphenicol [20%] was

also dispersed by the pharmacist at retail pharmacy outlet.

[figure.IV.2.f]

71

Figure.IV.2.f: Antibiotics consumed on Pharmacist dispersal at Retail Pharmacy Outlet

[Light green- Penicillins, dark pink- Chloramphenicol]

Ampicillin20%

Amoxycillin60%

Chloramphenicol20%

DISPERSED ANTIBIOTICS

72

Penicillins at the selected areas [figure.IV.2.g].

Amoxicillin was choice of antibiotic by doctors [57.1%] at private

sector and by pharmacist [42.9%] at private sector. Combinations of

amoxicillin with clavulanic acid and combination of pipericillin with

tazobactum were prescribed (100%) at private sector only. While

ampicillin (60%) and penicillin (33.3%) were choice of prescription at

public sector (government hospital) when compared to ampicillin

prescribed by doctors (33.3%) and pharmacist [6.7%] and penicillin

(66.7%) at private sector.

Quinolones at the selected areas [figure.IV.2.h].

The prescribing percentage of norfloxacin (80%) was high at public

sector and low (20%) at private sector. Ofloxacin and ciprofloxacin

were the only quinolone antibiotics prescribed and preferred at both

sectors. Ofloxacin (91.7%) was preferred at high percentage at private

sector, while low percentage (8.3%) is preferred at public sector.

In contrast ciprofloxacin was prescribed high (71.4%) at public sector

and low (28.6%) at private sector. Levofloxacin and Gatifloxacin were

prescribed exclusively (100%) at private sector.

73

Figure.IV.2.g: Penicillins usage at the selected areas.

57.1

100.0

33.3

66.7

100.0

60.0

33.342.9

6.7

0.0

20.0

40.0

60.0

80.0

100.0

120.0%

D

IST

RIB

UT

ION

ANTIBIOTICS

PENICILLINS

Private Public Pharmacist

74

Figure.IV.2.h: Quinolones usage at public and private sectors.

20.0

91.7

28.6

100.0 100.0

80.0

8.3

71.4

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Norfloxacin Ofloxacin Ciprofloxacin Levofloxacin Gatifloxacin

% D

IST

RIB

UT

ION

ANTIBIOTICS

Quinolones


75

Cephalosporins at the selected areas [figure.IV.2.i].

Cephalosporins were the categories which were prescribed only by

doctors at private sectors (100%).

Aminoglycosides usage at the selected areas [figure.IV.2.j].

Amikacin, Gentamycin and Tobramycin were the choice of

aminoglycosides at private sector only (100%).

Tetracyclines usage at the selected areas [figure.IV.2.k].

Doxycycline was prescribed at both public and private sectors. It

was prescribed at high percentage at public sector [54.5%] followed by

36.4% at private sector. And tetracycline was prescribed at public

sector only [100%].

Sulphonamides usage at the selected areas [figure.IV.2.l].

Under this category the only antibiotic recorded in the collected

prescriptions was co-trimoxazole [100%], a combination of

trimethoprim and sulfamethoxazole at public sector only.

Macrolides at the selected areas [figure.IV.2.m].

The data collected showed teicoplanin and clindamycin to be

prescribed only doctors of private sector [each 100%].

Oxazolidinones usage at selected areas [figure.IV.2.n].

Linezolid was prescribed only at private sector only [100%].

Chloramphenicol usage at selected areas [figure.IV.2.o].

Chloramphenicol was prescribed by pharmacist [100%] only at private

sector.

76

Figure.IV.2.i: Cephalosporin usage at the selected areas.

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0%

D

IST

RIB

UT

ION

ANTIBIOTICS

CEPHALOSPORINS


77

Figure.IV.2.j: Aminoglycosides usage at the selected areas.

100.0 100.0100.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Amikacin Gentamycin Tobramycin

%

DIS

TR

IBU

TIO

N

ANTIBIOTICS

AMINOGLYCOSIDES


78

Figure.IV.2.k: Tetracyclines usage at the selected areas.

36.4

54.5

100.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Doxycycline Tetracyclin

%

DIS

TR

IBU

TIO

N

ANTIBIOTICS

TETRACYCLINES


79

Figure.IV.2.l: Sulphonamides usage at the selected areas.

100.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Co-trimoxazole

% D

IST

RIB

UT

ION

SULPHONAMIDES


80

Figure.IV.2.m: Macrolides usage at the selected areas.

100.0 100.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Teicoplanin Clindamycin

% D

IST

RIB

UT

ION

ANTIBIOTICS

MACROLIDES


81

Figure.IV.2.n: Oxazolidinones usage at selected areas.

100.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0

LINEZOLID

% D

IST

RIB

UT

ION

OXAZOLIDINONES


82

Figure.IV.2.o: Chloramphenicol usage at selected areas.

100.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0%

D

istr

ibuti

on

CHLORAMPHENICOL

CHLORAMPHENICOL


83

Antibiotic therapy for the common infections

The infections for which doctors prescribe antibiotics were like

[URTIs] Upper Respiratory Tract Infections and [UTIs] Urinary Tract

Infections are the common infections suffered by patients, followed by

infection developed due to wounds or injuries. However, the

antibiotics for other infections such as in ophthalmology, orthopedic,

gynecology, neurology have been observed as low percentage. The

commonly reported URTIs are high at private (47.9%) sectors than at

public (41.7%) with clinical manifestations such as cold, cough, fever,

throat soars, tonsillitis are also dependent on antibiotics treatment.

Further, UTIs also reported considerably high at private [61.5%] than

at public [38.5%). In addition, the other common clinical

manifestations by the patients in the survey were abdominal pain,

dysuria, and fever. However, the wound infections (WI) cases were

high at private [70.0%] than at [30%] public sectors. Low prescriptions

included gastrointestinal [GI] problems with high of 80.6% at private

and 19.4% at public health sector. Neurological problems included

high at private [87.5%] than at public [12.5%] health sectors. Other

includes opthamological, orthopedical problems. [figure.IV.2.p]

As respiratory, urinary and wound infections were the common

infections for which antibiotic prescribing patterns were observed and

highlighted. Co-trimoxazole (32%) is larger prescribed antibiotic and

Ciprofloxacin and Ofloxacin (4% each) are least prescribed for RTI at

public health centre, and in contrast to the finding at public sector,

84

Ofloxacin is highly prescribed and Amoxicillin, Ciprofloxacin and

Gentamycin (2.9% each) are least prescribed at private sector.

Norfloxacin is prescribed high at both public (50%) and private

(33.3%) health centers and least is Doxycycline at public and

Ofloxacin at private health centre for UTIs. Doxycycline and Ampicillin

(31.3% each) and Ciprofloxacin and Tetracycline (18.8% each), were

prescribed at high and low percentage for wound infection at public

health centre and private practitioners. They preferred more

Doxycycline and Amikacin (21.1% each) than Ciprofloxacin (5.3%)

which is least. [table.IV.2.c]

85

Figure.IV.2.p: Antibiotics prescribed by doctors at public [Government hospital] and private sectors [Private

hospital and retail pharmacy outlet] and dispersed by pharmacist at private sector [Retail pharmacy outlet] for

different infections.

41.738.5

19.4

30.0

12.5

16.7

47.9

61.5

80.6

70.0

87.5

75.0

10.48.3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

URTI UTI GI Problems Injury or wound Neurological problems

Others

% D

IST

RIB

UT

ION

INFECTIONS

Public Private Pharmacist

86

Table.IV.2.c: Antibiotics prescribed for RTI [Respiratory Tact

Infections], UTI [Urinary Tract Infections] and Wound/Injury.

S. No Antibiotics Public Health Centre Private Health Centre

Respiratory Tract Infections

1 Ampicillin 28.0 5.7

2 Amoxicillin 0.0 2.9

3 Amoxicillin+Clavunate 0.0 22.9

4 Amikacin 0.0 17.1

5 Ciprofloxacin 4.0 2.9

6 Co- trimoxazole 32.0 0.0

7 Doxycycline 16.0 8.6

8 Gentamycin 0.0 2.9

9 Linezolid 0.0 5.7

10 Norfloxacin 16.0 0.0

11 Ofloxacin 4.0 31.4

Urinary Tract Infections


2 Amoxicillin 0.0 17.6

3 Amoxicillin+Clavunate 0.0 23.5

4 Amikacin 0.0 11.8


6 Norfloxacin 7.1 0.0

Wound/Injury

1 Amikacin 0.0 21.1



4 Doxycycline 31.3 21.1

5 Gentamycin 0.0 10.5

6 Ofloxacin 0.0 15.8

7 Penicillin 0.0 10.5

8 Tetracycline 18.8 0.0

Percentage distribution of prescribed antibiotics at both public and

private health centers is represented in the table.

87

The total cost that is spent on the antibiotics prescribed at private

sector [retail pharmacy outlet] was RS: 394. 70 [three hundred and

ninety four rupees and seventy paise] with an average of RS: 26.30 per

individual antibiotic, while at private hospital RS: 7557.10 [seven

thousand five hundred and fifty seven rupees and ten paise] with an

average of RS: 302.30 per individual antibiotic was recorded in the

study. Dispersed antibiotics was said to cost RS: 197.00 [one hundred

and ninety seven rupees] with an average of 19.7 per individual

antibiotic. [table.IV.2.c]

Cost that is expected to be spent on the antibiotics at public sector

was RS: 962.50 [nine hundred and sixty two rupees and fifty paise]

with an average of RS: 96.30 per individual antibiotic. [table.IV.2.c]

88

Table.IV.2.d: Cost towards antibiotics at the selected areas

S. No AREA TOTAL COST MEAN±SD

1. Public Health Sector

Government hospital

962.5

96.3±12.0

2.

Private Health Sector

Private Hospital

Retail Pharmacy

Outlet

7557.1

394.7

302.3±22.2

26.3±4.3

89

IV.3. ANTIBIOTIC SUCEPTIBILTIY PROFILE

The study related to antibiotic susceptibility was performed at:

Public sector- Government hospital lab

Private sector - Private hospital lab

- Private labs

During the study following observations were elucidated from the

culture reports:

Infection profile

Organism’s profile

Antibiotic susceptibility profile

The retrospective study was conducted at the selected area’s

microbiological labs. A yearlong data was collected in order to find the

above observation in particularly the study was about antibiotic

resistance.

The culture sensitivity tests were performed by Kirby Bauer

methods. A total of 1424 sample records were collected, of them 676

were positive to infections and 748 were negative to infections.

INFECTION PROFILE

The infection profile at the selected areas was 46% positive and

54% negative. From the positive samples, rate of infection was

observed to be 18% at public sector [government hospital lab] followed

by 28% private sector which includes 15% at private lab and 13 % at

private hospital lab [figure.IV.3.a].

90

Figure.IV.3.a: Percentage distribution of culture sensitive reports at Private sector and Public sector

Negative

54%

Private Lab15%

Public Sector 18%

Private Hospitallab 13%

Positive

46%

PROFILE OF CULTURE SENSITIVE REPORTS

Private Sector 28%

Governme

nt HospitalLab 18%

91

Infection profile with respect to sex showed males being more

positive to infections than females at all the areas. 61.2% males were

positive to infections and 38.8% females at public sector [Government

hospital lab] followed by 54.9% males showed high infections than

45.1% females at private sector [Private hospital lab and private labs].

[figure.IV.3.b]

Different biological samples were observed to carry infection by

various gram positive and gram negative bacteria. The different

samples collected in the study were 547 urine samples, 124 stool

samples, 220 blood samples, 141 sputum, 28 throat swab and 364

pus samples.

The collected 547 urine samples showed 54.5% negative and 45.5%

positive to infections. Next to urine sample, 364 pus samples were the

highest to carry infection showing 39.8% negative and 60.2% positive

to infections. The third largest biological sample was 220 blood

samples which showed 78.2% negative and 21.8% positive followed by

141 sputum samples with 55.3% negative and 44.7% positive for

infections. Next to sputum samples, 124 stool samples had 59.7%

negative and 40.3% were positive to infections and lastly 28 throat

swab samples showed 28.6% negative and 71.4% positive for

infections [figure.IV.3.c].

92

Figure.IV.3.b: Percentage prevalence of infection with respect to sex at the selected areas.

MALE , 54.9%

MALE , 61.2%

FEMALE , 45.1%

FEMALE , 38.8%

0 10 20 30 40 50 60 70

Private

sector

Lab [408]

Public

sector

Lab [268]

% DISTRIBUTION

INFECTION PROFILE WITH RESPECT TO SEX

93

Figure.IV.3.c: Percentage prevalence of infection in biological samples at the selected areas.

45.5

40.3

21.8

44.7

71.4

60.2

54.5

59.7

78.2

55.3

28.6

39.8

0.0 20.0 40.0 60.0 80.0 100.0

URINE [547]

STOOL [124]

BLOOD [220]

SPUTUM [141]

THROAT SWAB

[28]

PUS

[364]

% DISTRIBUTION

INFECTION PROFILE IN BIOLOGICAL SAMPLES

Positive Negative

94

ORGANISMS PROFILE

In the study the infections were caused by various organisms. The

samples constituted 45.4% gram negative and 54.6% gram positive

organisms. Infections were caused high by 26% Escherichia coli, 22%

Streptococcus pneumoniae, 21% Staphylococcus aureus, 12% Klebsiella

pneumoniae, 7% Pseudomonas aeruginosa, 7% Enterococcus faecalis

and 5% Staphylococcus albus. [figure.IV.3.d]

Infection profile by different organisms in various biological samples

showed:

Urine [figure.IV.3.e]

The bacteriological findings in urine sample was obviously high by

47% Escherichia coli followed by the next organisms of 20% Klebsiella

pneumoniae, 13% Staphylococcus aureus, 11% Enterococcus faecalis,

5% Streptococcus pneumoniae and 4% Pseudomonas aeruginosa.

Stool [figure.IV.3.f]

Similarly the infection in stool sample was high by 81%

Escherichia coli followed by the next organisms of 9% Staphylococcus

aureus, 8% Enterococcus faecalis and 2% Pseudomonas aeruginosa.

Klebsiella pneumonia was found to be absent in this sample.

Blood [figure.IV.3.g]

The blood samples showed high rate of infection by 37%

Staphylococcus albus, 27% Staphylococcus aureus followed by 15%

Escherichia coli, 10% Enterococcus faecalis and least of 2% by

Klebsiella pneumoniae and 2% Pseudomonas aeruginosa.

95

Figure.IV.3.d: Organism profile in the selected area

E.coli

26%

K.pneumoniae

12%

S.aureus

21%

E.faecalis

7%

P.aeruginosa

7%

Strep.pneumonia

e

22%

S.albus

5%

ORGANISM PROFILE

96

Figure.IV.3.e: Organism profile in urine

E.coli

47%

K.pneumoniae

20%

S.aureus

13%

E.faecalis

11%

P.aeruginosa

4%

S.pneumoniae

5%

URINE SAMPLE

97

Figure.IV.3.f: Organism profile in stool

E.coli81%

S.aureus9%

E.faecalis8%

P.aeruginosa2%

STOOL SAMPLE

98

Figure.IV.3.g: Organism profile in blood

E.coli

15%

K.pneumoniae

2%

S.aureus

27%

E.faecalis

10%

P.aeruginosa

2%

Strep.pneumoniae

7%

S.albus

37%

BLOOD SAMPLE

99

Sputum [figure.IV.3.h]

Bacteriological finding in sputum samples showed high infection by

72% Streptococcus pneumoniae, 12% Staphylococcus aureus, 11%

Klebsiella pneumoniae followed by 2% Pseudomonas aeruginosa, 2%

Escherichia coli and least by 1% Enterococcus faecalis.

Throat swab [figure.IV.3.i]

The bacteriological findings in throat swab sample showed high rate

of infection by 32% Streptococcus pneumoniae, 28% Staphylococcus

aureus, 16% Klebsiella pneumoniae and least by 12% Escherichia coli

and 12% Pseudomonas aeruginosa.

Pus [figure.IV.3.j]

High rate of infection was observed by 36% Staphylococcus aureus,

next to it was 16% Pseudomonas aeruginosa and 16% Escherichia coli,

15% Streptococcus pneumoniae, 9% Klebsiella pneumoniae and 5%

Enterococcus faecalis and least by 3% Staphylococcus albus.

ANTIBIOTIC SUSCEPTIBILITY PROFILE

The next point of observation was the antibiotic susceptibility

patterns by different organisms in different biological samples. The

positive culture reports showed varied responses to different

antibiotics by the organisms in the biological samples. There were

about 56 different type of antibiotics used to carry out the culture

sensitive tests in different selected areas. Of these antibiotics the

highest frequency of antibiotics exhibiting resistance and sensitivity

profile were evaluated.

100

Figure.IV.3.h: Organism profile in sputum

E.coli

2%K.pneumoniae

11%

S.aureus

12%

E.faecalis

1%

P.aeruginosa

2%Strep.pneumoia

e72%

SPUTUM SAMPLE

101

Figure.IV.3.i: Organism profile in throat swab

E.coli

12%

K.pneumoniae

16%

S.aureus

28%

P.aeruginosa

12%

Strep.pneu

32%

THROAT SWAB SAPMLE

102

Figure.IV.3.j: Organism profile in pus

E.coli

16%

K.pneumoniae

9%

S.aureus

36%

E.faecalis

5%

P.aeruginosa

16%

Strep.pneumonia

e15%

S.albus

3%

PUS SAMPLE

103

The top antibiotics which showed susceptibility rates by resistance

and sensitivity were ciprofloxacin, amoxicillin, ceftazidime,

kanamycin, amikacin, gentamycin, co-trimoxazole, norfloxacin,

azithromycin and nalidixic acid, which are grouped under categories

such as quinolones, aminoglycosides, penicillins, cephalosporins,

sulphonamides and macrolides [figure.IV.3.k].

Among quinolones, ciprofloxacin was 64.4% resistance and 35.5%

sensitive while norfloxacin was 71.3% resistance and 28.7% sensitive

and nalidixic acid was 78.9% resistance and 21.1% sensitive.

Under Penicillin class, amoxicillin was 78.8% resistance and 21.2%

sensitive.

Three aminoglycosides topped the susceptibility patterns which

were amikacin, kanamycin and gentamycin. Kanamycin was 58.1%

resistance and 41.9% sensitive, gentamycin 76.4% resistance and

23.6%, while amikacin was 66.9% sensitive and 33.1% resistance.

Ceftazidime was observed to be 71.1% resistance and 28.9%

sensitive.

Co-trimoxazole was the only sulphonamide which showed 80.6%

resistance and 19.4% sensitive.

Under macrolides azithromycin was 55.1% resistance and 44.9%

sensitive.

104

Figure.IV.3.k: Overall percentage distribution of antibiotic susceptibility patterns.

78.9%

55.1%

71.3%

80.6%

76.4%

33.1%

58.1%

71.1%

78.8%

64.4%

21.1%

44.9%

28.7%

19.4%

23.6%

66.9%

41.9%

28.9%

21.2%

35.6%

RESISTANCE SENSITIVITY

Ciprofloxacin [326]

Amoxicillin [292]

Ceftazidime [291]

Kanamycin [277]

Amikacin [269]

Gentamycin [259]

Co-Trimoxazole [248]

Norfloxacin [247]

Azithromycin [234]

Nalidixic acid [228]

105

ANTIBIOTIC SUSCEPTIBILITY IN URINARY ISOLATES

Gram positive organisms

Under gram positive organisms Staphylococcus aureus,

Enterococcus faecalis and Streptococcus pneumoniae were observed to

be isolated from the urine sample. [Table.IV.3.a]

S. aureus was highly resistant to amoxicillin- 72.7%, nalidixic acid-

66.7%, ciprofloxacin- 63.6%, co- trimoxazole- 62.5%, norfloxacin-

62.5%, ceftazidime- 60.0%, amikacin- 60.0% and least by kanamycin-

55.6%. On the other hand sensitivity was observed towards

azithromycin- 62.5% and gentamycin- 55.6%.

E. faecalis showed high rate of resistance to nalidixic acid- 88.9%,

norfloxacin- 83.3%, gentamycin- 72.7%, ceftazidime- 71.4%, co-

trimoxazole- 69.2%, amoxicillin- 63.6%, kanamycin- 63.6% and lastly

ciprofloxacin- 60.0%. High sensitivity percentage was observed

towards azithromycin- 80.0% and amikacin- 71.4%.

Strep. pneumoniae showed 100% resistance to co-trimoxazole,

norfloxacin, azithromycin and nalidixic acid and 66.7% to gentamycin

and 65.6% to amoxicillin. Ciprofloxacin- 75% and ceftazidime- 75%

were sensitive while kanamycin was 50% resistance and 50%

sensitive. Nil response was shown towards amikacin by Strep.

pneumoniae isolated from the urine samples.

Gram negative organisms

Escherichia coli, Klebsiella pneumoniae and Pseudomonas

aeruginosa were the organisms isolated from the urine sample

106

collected for the culture sensitive test. [Table.IV.3.a]

E. coli showed 100% resistance to amoxicillin followed by 92.6% to

nalidixic acid, 91.9% to ciprofloxacin, 78.1% to co- trimoxazole, 66.7%

to norfloxacin, 62.5% to kanamycin, 61.5% to gentamycin and 60.0%

to ceftazidime. On the other hand amikacin – 79.25 and azithromycin

– 65.2% were showing sensitive patterns.

K. pneumoniae showed resistance patterns to all antibiotics except

amikacin, whose resistance rate was 14.3% and sensitive rate was

85.7%, amoxicillin – 96.3% showed high resistance rates followed by

gentamycin – 83.3%, co – trimoxazole – 82.4%, norfloxacin – 82.4%,

nalidixic acid – 80.0%, ciprofloxacin – 58.6%, ceftazidime – 57.7%,

azithromycin – 57.1% and kanamycin – 57.1%.

P. aeruginosa was 100% resistance to ciprofloxacin, amoxicillin, co-

trimoxazole and norfloxacin followed by 80.0% resistance to

kanamycin, gentamycin and nalidixic acid and followed by 66.7% to

azithromycin. Amikacin showed 50% resistance and 50% sensitivity.

107

Table.IV.3.a: Antibiotic susceptibility patterns in urinary isolates. [Figures are represented in percentage]

Gram Positive organisms – Urine sample

S. No Antibiotics Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae Staphylococcus albus

Resistance Sensitivity Resistance Sensitivity Resistance Sensitivity Resistance Sensitivity

1. Ciprofloxacin 63.6 36.4 60.0 40.0 25.0 75.0 0.0 0.0

2. amoxicillin 72.7 27.3 63.6 36.4 65.6 34.4 0.0 0.0

3. Ceftazidime 60.0 40.0 71.4 28.6 25.0 75.0 0.0 0.0

4. Kanamycin 55.6 44.4 63.6 36.4 50.0 50.0 0.0 0.0

5. Amikacin 60.0 40.0 28.6 71.4 0.0 0.0 0.0 0.0

6. gentamycin 44.4 55.6 72.7 27.3 66.7 33.3 0.0 0.0

7. Co-Trimoxazole 62.5 37.5 69.2 30.8 100.0 0.0 0.0 0.0

8. Norfloxacin 62.5 37.5 83.3 16.7 100.0 0.0 0.0 0.0

9. Azithromycin 37.5 62.5 20.0 80.0 100.0 0.0 0.0 0.0

10. Nalidixic acid 66.7 33.3 88.9 11.1 100.0 0.0 0.0 0.0

Gram Negative organisms – Urine sample

S. No Antibiotics Escherichia coli Klebsiella pneumoniae Pseudomonas aeruginosa

Resistance Sensitivity Resistance Sensitivity Resistance Sensitivity

1. Ciprofloxacin 91.9 8.1 58.6 41.4 100.0 0.0

2. amoxicillin 100.0 0.0 96.3 3.7 100.0 0.0

3. Ceftazidime 60.0 40.0 57.7 42.3 0.0 0.0

4. Kanamycin 62.5 37.5 57.1 42.9 80.0 20.0

5. Amikacin 20.8 79.2 14.3 85.7 50.0 50.0

6. gentamycin 61.5 38.5 83.3 16.7 80.0 20.0

7. Co-Trimoxazole 78.1 21.9 82.4 17.6 100.0 0.0

8. Norfloxacin 66.7 33.3 82.4 17.6 100.0 0.0

9. Azithromycin 34.8 65.2 57.1 42.9 66.7 33.3

10. Nalidixic acid 92.6 7.4 80.0 20.0 80.0 20.0

108

ANTIBIOTIC SUSCEPTIBILITY IN STOOL ISOLATES


Staphylococcus aureus and Enterococcus faecalis were the two gram

positive organisms isolated from stool sample. [TableIV.3.b]

S. aureus showed 100% resistance to ciprofloxacin and amoxicillin.

The other antibiotics which showed resistance patterns were co-

trimoxazole – 75.0% and norfloxacin – 66.7%. Amikacin and

azithromycin showed 100% sensitivity followed by ceftazidime and

nalidixic acid showed 75% and lastly kanamycin and gentamycin

showed 66.7% sensitivity.

E. faecalis isolated from stool sample showed 100% resistance to

ciprofloxacin, amoxicillin, kanamycin, gentamycin, co- trimoxazole

and nalidixic acid, while ceftazidime was 100% sensitive followed by

66.7% sensitivity by amikacin and azithromycin. Norfloxacin was the

antibiotic with 50% sensitivity and 50% resistance.


E. coli showed resistance to gentamycin- 82.4%, amoxicillin- 81.3%,

ciprofloxacin- 76.5%, kanamycin- 63.2%, norfloxacin- 61.5%, nalidixic

acid- 61.1%, azithromycin- 60.0%, co- trimoxazole and ceftazidime

were 55.6%. Only amikacin was 78.3% sensitive in the tested

antibiotics.

P. aeruginosa was 100% resistance to ciprofloxacin, kanamycin,

gentamycin, co- trimoxazole, norfloxacin and azithromycin.

Amoxicillin, ceftazidime, amikacin and nalidixic acid showed nil

response to tests done.

109

Table.IV.3.b: Antibiotic susceptibility patterns in stool isolates. [Figures are represented in percentage]

Gram Positive Organisms – Stool sample


Resistance Sensitive Resistance Sensitive Resistance Sensitive Resistance Sensitive

1 Ciprofloxacin 100.0 0.0 100.0 0.0 0.0 0.0 0.0 0.0

2 Amoxicillin 100.0 0.0 100.0 0.0 0.0 0.0 0.0 0.0

3 Ceftazidime 25.0 75.0 0.0 100.0 0.0 0.0 0.0 0.0

4 Kanamycin 33.3 66.7 100.0 0.0 0.0 0.0 0.0 0.0

5 Amikacin 0.0 100.0 33.3 66.7 0.0 0.0 0.0 0.0

6 Gentamycin 33.3 66.7 100.0 0.0 0.0 0.0 0.0 0.0

7 Co-trimoxazole 75.0 25.0 100.0 0.0 0.0 0.0 0.0 0.0

8 Norfloxacin 66.7 33.3 50.0 50.0 0.0 0.0 0.0 0.0

9 Azithromycin 0.0 100.0 33.3 66.7 0.0 0.0 0.0 0.0

10 Nalidixic acid 25.0 75.0 100.0 0.0 0.0 0.0 0.0 0.0

Gram Negative Organisms – Stool sample


Resistance Sensitive Resistance Sensitive Resistance Sensitive

1 Ciprofloxacin 76.5 23.5 0.0 0.0 100.0 0.0

2 Amoxicillin 81.3 18.8 0.0 0.0 0.0 0.0

3 Ceftazidime 55.6 44.4 0.0 0.0 0.0 0.0

4 Kanamycin 63.2 36.8 0.0 0.0 100.0 0.0

5 Amikacin 21.7 78.3 0.0 0.0 0.0 100.0

6 Gentamycin 82.4 17.6 0.0 0.0 100.0 0.0

7 Co-trimoxazole 55.6 44.4 0.0 0.0 100.0 0.0

8 Norfloxacin 61.5 38.5 0.0 0.0 100.0 0.0

9 Azithromycin 60.0 40.0 0.0 0.0 100.0 0.0

10 Nalidixic acid 61.1 38.9 0.0 0.0 0.0 0.0

110

ANTIBIOTIC SUSCEPTIBILITY IN BLOOD ISOLATES


Bacteriological findings in blood samples under gram positive

category were Staphylococcus aureus, Enterococcus faecalis,

Streptococcus pneumoniae and Staphylococcus albus. [Table.IV.3.c]

S. aureus was resistant to ceftazidime- 80.0%, co- trimoxazole-

66.7%, amoxicillin- 62.5%, kanamycin-60.0%, norfloxacin- 60.0% and

azithromycin- 60.0%. On the other hand amikacin- 83.3%,

ciprofloxacin- 77.8% and nalidixic acid- 66.7% showed sensitive

patterns and gentamycin was 50% resistance and 50% sensitive.

E. faecalis showed 83.3% resistance towards gentamycin and

co-trimoxazole followed by 66.7% resistance to amoxicillin. Kanamycin

and amikacin showed 100% sensitive patterns followed by

azithromycin- 80.0% and norfloxacin- 66.7%. Nalidixic acid and

ceftazidime were 50% resistance and 50% sensitive.

Strep. pneumoniae showed 100% resistance to co- trimoxazole,

azithromycin and nalidixic acid followed by gentamycin- 83.3%, and

amoxicillin- 60.0%. Amikacin and kanamycin were 100% sensitive

followed by norfloxacin-66.7%. Ceftazidime was 50% sensitive and

50% resistance and nil response to ciprofloxacin.

S. albus showed highest resistance to co-trimoxazole- 87.5%

followed by amoxicillin- 80%, gentamycin- 77.8%, nalidixic acid-

75.0%, ceftazidime 62.5%, kanamycin 61.5%, norfloxacin 58.3%,

ciprofloxacin- 53.8% and amikacin and azithromycin were 50.0%

resistant and 50.0% sensitive.

111

Gram negative organism

E. coli showed 100% resistance to ceftazime and co- trimoxazole

followed by amoxicillin- 80.0%, gentamycin- 75.0%, norfloxacin-

66.7%, amikacin- 66.7%, azithromycin- 60.0% and ciprofloxacin-

57.1%. On the other hand nalidixic acid was 100% and amikacin was

66.7% sensitive.

K. pneumoniae was 100% resistance to kanamycin.

P. aeruginosa showed resistance to co- trimoxazole- 87.5%,

gentamycin- 77.8%, kanamycin- 68.8% and norfloxacin- 58.3%.

Azithromycin- 57.1% was sensitive antibiotic in the test along with

ciprofloxacin and amikacin were 50% resistance and 50% sensitive.

112

Table.IV.3.c: Antibiotic susceptibility patterns in blood isolates. [Figures are represented in percentage]

Gram Positive Organisms - Blood Sample



1 Ciprofloxacin 22.2 77.8 0.0 0.0 0.0 0.0 53.8 46.2

2 Amoxicillin 62.5 37.5 66.7 33.3 60.0 40.0 80.0 20.0

3 Ceftazidime 80.0 20.0 50.0 50.0 50.0 50.0 62.5 37.5

4 Kanamycin 60.0 40.0 0.0 100.0 0.0 100.0 61.5 38.5

5 Amikacin 16.7 83.3 0.0 100.0 0.0 100.0 50.0 50.0

6 Gentamycin 50.0 50.0 83.3 16.7 83.3 16.7 77.8 22.2

7 Co-trimoxazole 66.7 33.3 83.3 16.7 100.0 0.0 87.5 12.5

8 Norfloxacin 60.0 40.0 33.3 66.7 33.3 66.7 58.3 41.7

9 Azithromycin 60.0 40.0 20.0 80.0 100.0 0.0 50.0 50.0

10 Nalidixic acid 33.3 66.7 50.0 50.0 100.0 0.0 75.0 25.0

Gram Negative Organisms - Blood Sample



1 Ciprofloxacin 57.1 42.9 0.0 0.0 50.0 50.0

2 Amoxicillin 80.0 20.0 0.0 0.0 0.0 0.0

3 Ceftazidime 100.0 0.0 0.0 0.0 0.0 0.0

4 Kanamycin 33.3 66.7 100.0 0.0 68.8 31.3

5 Amikacin 66.7 33.3 0.0 0.0 50.0 50.0

6 Gentamycin 75.0 25.0 0.0 0.0 77.8 22.2

7 Co-trimoxazole 100.0 0.0 0.0 0.0 87.5 12.5

8 Norfloxacin 66.7 33.3 0.0 0.0 58.3 41.7

9 Azithromycin 60.0 40.0 0.0 0.0 42.9 57.1

10 Nalidixic acid 0.0 100.0 0.0 0.0 0.0 0.0

113

ANTIBIOTIC SUSCEPTIBILITY IN SPUTUM ISOLATES


Staphylococcus aureus, Enterococcus faecalis and Streptococcus

pneumoniae were the bacteriological findings under gram positive

organisms in sputum samples. [Table.IV.3.d]

S. aureus showed resistance to nalidixic acid- 87.5%, norfloxacin-

77.8%, co- trimoxazole- 66.7%, kanamycin- 61.5% and amoxicillin-

60.0%. Azithromycin- 66.7%, amikacin- 60.0%, ceftazidime- 55.6%,

gentamycin- 55.6% and ciprofloxacin- 54.5% were sensitive in their

activity.

E. faecalis was 100% resistance to amoxicillin, co- trimoxazole,

norfloxacin, azithromycin and nalidixic acid. Amikacin was the only

antibiotic with 100% sensitivity.

S. pneumoniae was 100% resistant to co- trimoxazole, azithromycin

and nalidixic acid followed by gentamycin- 80.0% and norfloxacin-

66.7%. Amikacin was 100% sensitive followed by ciprofloxacin- 80.0%,

ceftazidime- 75.0% and amoxicillin- 62.5%. Kanamycin was 50.0%



Escherichia coli, Klebsiella pneumoniae and Pseudomonas

aeruginosa were the isolates from blood samples. [Table.IV.3.d]

E. coli was 100% resistant to amoxicillin, ceftazidime, gentamycin

and azithromycin followed by amikacin- 66.7% while ciprofloxacin was

50.0% resistant and 50.0% sensitive.

114

K. pneumoniae showed resistance towards azithromycin- 75.0%,

amoxicillin- 71.4%, co- trimoxazole- 66.7% and ciprofloxacin- 61.5%,

while ceftazidime- 80.0%, amikacin- 80.0%, norfloxacin-66.7% and

kanamycin- 57.1% were sensitive.

P. aeruginosa was 100% resistant to ciprofloxacin, amoxicillin,

kanamycin, gentamycin and co- trimoxazole. While azithromycin was

100% sensitive and amikacin was 60% sensitive. Lastly ceftazidime

was 50.0% resistant and 50.0% sensitive.

115

Table.IV.3.d: Antibiotic susceptibility patterns in sputum isolates

Gram Positive Organisms - Sputum sample

S.No Antibiotics Staphylococcus aureus

Enterococcus faecalis Streptococcus pneumoniae Staphylococcus albus


1 Ciprofloxacin 45.5 54.5 0.0 0.0 20.0 80.0 0.0 0.0

2 Amoxicillin 60.0 40.0 100.0 0.0 37.5 62.5 0.0 0.0

3 Ceftazidime 44.4 55.6 0.0 100.0 25.0 75.0 0.0 0.0

4 Kanamycin 61.5 38.5 0.0 0.0 50.0 50.0 0.0 0.0

5 Amikacin 40.0 60.0 0.0 0.0 0.0 100.0 0.0 0.0

6 Gentamycin 44.4 55.6 0.0 0.0 80.0 20.0 0.0 0.0

7 Co-trimoxazole 66.7 33.3 100.0 0.0 100.0 0.0 0.0 0.0

8 Norfloxacin 77.8 22.2 100.0 0.0 66.7 33.3 0.0 0.0

9 Azithromycin 33.3 66.7 100.0 0.0 100.0 0.0 0.0 0.0

10 Nalidixic acid 87.5 12.5 100.0 0.0 100.0 0.0 0.0 0.0

Gram Negative Organisms - Sputum sample

S.No Antibiotics Escherichia coli Klebsiella pneumoniae Pseudomonas aeruginosa


1 Ciprofloxacin 50.0 50.0 61.5 38.5 100.0 0.0

2 Amoxicillin 100.0 0.0 71.4 28.6 100.0 0.0

3 Ceftazidime 100.0 0.0 20.0 80.0 50.0 50.0

4 Kanamycin 0.0 0.0 42.9 57.1 100.0 0.0

5 Amikacin 66.7 33.3 20.0 80.0 40.0 60.0

6 Gentamycin 100.0 0.0 50.0 50.0 100.0 0.0

7 Co-trimoxazole 0.0 0.0 66.7 33.3 100.0 0.0

8 Norfloxacin 0.0 0.0 33.3 66.7 0.0 0.0

9 Azithromycin 100.0 0.0 75.0 25.0 0.0 100.0

10 Nalidixic acid 0.0 0.0 50.0 50.0 0.0 0.0

116

ANTIBIOTIC SUSCEPTIBILITY IN THROAT SWAB ISOLATES


Staphylococcus aureus and Streptococcus pneumoniae were the

bacteriological finding among gram positive isolates from throat

swabs. [Table.IV.3.e]

S. aureus showed 100% resistance to gentamycin. Amoxicillin was

83.3% resistant. On the other hand ciprofloxacin, ceftazidime,

kanamycin, amikacin, norfloxacin and azithromycin showed 100%

sensitive. Co- trimoxazole showed 50.0% resistance and 50.0%

sensitive.

Strep. pneumoniae showed 100% resistance to co- trimoxazole.

Ciprofloxacin, amikacin and norfloxacin showed 50% resistance and

50.0% sensitivity. Gentamycin showed 100% sensitivity followed by

amoxicillin- 66.7%, ceftazidime- 62.5% and kanamycin- 60.0%.


Escherichia coli, Klebsiella pneumonia and Pseudomonas

aeruginosa were the organisms isolated from throat swabs.

[Table.IV.3.e]

E.coli showed 100% resistance to ciprofloxacin, ceftazidime,

kanamycin, amikacin, gentamycin, co- trimoxazole, norfloxacin,

azithromycin and nalidixic acid. Amoxicillin showed 50.0% resistance

and 50.0% sensitivity.

117

Table.IV.3.e: Antibiotic susceptibility patterns in throat swab isolates. [Figures are represented in percentage]

Gram Positive Organisms - Throat swab sample

S.No Antibiotics Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae

Staphylococcus albus


1 Ciprofloxacin 0.0 100.0 0.0 0.0 50.0 50.0 0.0 0.0

2 Amoxicillin 83.3 16.7 0.0 0.0 33.3 66.7 0.0 0.0

3 Ceftazidime 0.0 100.0 0.0 0.0 37.5 62.5 0.0 0.0

4 Kanamycin 0.0 100.0 0.0 0.0 40.0 60.0 0.0 0.0

5 Amikacin 0.0 100.0 0.0 0.0 50.0 50.0 0.0 0.0

6 Gentamycin 100.0 0.0 0.0 0.0 0.0 100.0 0.0 0.0

7 Co-trimoxazole 50.0 50.0 0.0 0.0 100.0 0.0 0.0 0.0

8 Norfloxacin 0.0 100.0 0.0 0.0 50.0 50.0 0.0 0.0

9 Azithromycin 0.0 100.0 0.0 0.0 0.0 0.0 0.0 0.0

10 Nalidixic acid 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Gram Negative Organisms – Throat swab sample



1 Ciprofloxacin 100.0 0.0 66.7 33.3 100.0 0.0

2 Amoxicillin 50.0 50.0 66.7 33.3 0.0 0.0

3 Ceftazidime 100.0 0.0 100.0 0.0 0.0 0.0

4 Kanamycin 100.0 0.0 0.0 100.0 100.0 0.0

5 Amikacin 100.0 0.0 100.0 0.0 0.0 100.0

6 Gentamycin 100.0 0.0 100.0 0.0 100.0 0.0

7 Co-trimoxazole 100.0 0.0 0.0 0.0 100.0 0.0

8 Norfloxacin 100.0 0.0 0.0 0.0 100.0 0.0

9 Azithromycin 100.0 0.0 100.0 0.0 100.0 0.0

10 Nalidixic acid 100.0 0.0 0.0 0.0 0.0 0.0

118

K. pneumoniae also showed 100% resistance ceftazidime,

amikacin, gentamycin and azithromycin followed ciprofloxacin- 66.7%

and amoxicillin- 66.7%.

P. aeruginosa was 100% resistant to ciprofloxacin, kanamycin,

gentamycin, norfloxacin and azithromycin. Similarly amikacin showed

100% resistance.

ANTIBIOTIC SUSCEPTIBILITY IN PUS SAMPLES


Staphylococcus aureus, Enterococcus faecalis, Streptococcus

pneumoniae and staphylococcus albus were the organisms isolated

from pus samples. [Table.IV.3.f]

S. aureus were resistant to ceftazidime- 82.4%, nalidixic acid-

81.8%, norfloxacin- 80.0%, azithromycin- 72.2% and amoxicillin-

52.6%. Amikacin- 76.9%, gentamycin- 66.7%, co- trimoxazole- 62.5%,

while ciprofloxacin- 62.5% and kanamycin- 54.2% were sensitive

antibiotics.

E. faecalis showed 100% resistance to amoxicillin and gentamycin

followed by ceftazidime- 87.5%, nalidixic acid- 80.0%, norfloxacin-

71.4%, ciprofloxacin- 66.7% and co- trimoxazole- 60.0%. In contrast

amikacin and azithromycin showed 100% sensitivity followed by

kanamycin- 70.0%.

Strep. pneumoniae showed 100% resistance to gentamycin, co-

trimoxazole, azithromycin and nalidixic acid. Amoxicillin was 100%

sensitive followed by ciprofloxacin- 75.0%, ceftazidime- 75%,

119

Table.IV.3.f: Antibiotic susceptibility patterns in pus isolates

Gram Positive Organisms - Pus samples

S.No Antibiotics Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae Staphylococcus albus


1 Ciprofloxacin 37.5 62.5 66.7 33.3 25.0 75.0 33.3 66.7

2 Amoxicillin 52.6 47.4 100.0 0.0 0.0 100.0 50.0 50.0

3 Ceftazidime 82.4 17.6 87.5 12.5 25.0 75.0 40.0 60.0

4 Kanamycin 45.8 54.2 30.0 70.0 35.0 65.0 100.0 0.0

5 Amikacin 23.1 76.9 0.0 100.0 34.8 65.2 33.3 66.7

6 Gentamycin 33.3 66.7 100.0 0.0 100.0 0.0 50.0 50.0

7 Co-trimoxazole 37.5 62.5 60.0 40.0 100.0 0.0 100.0 0.0

8 Norfloxacin 80.0 20.0 71.4 28.6 38.5 61.5 100.0 0.0

9 Azithromycin 72.2 27.8 0.0 100.0 100.0 0.0 66.7 33.3

10 Nalidixic acid 81.8 18.2 80.0 20.0 100.0 0.0 100.0 0.0

Gram Negative Organisms - Pus samples



1 Ciprofloxacin 70.0 40.0 50.0 50.0 50.0 50.0

2 Amoxicillin 93.8 12.5 63.6 36.4 83.3 16.7

3 Ceftazidime 64.7 11.8 75.0 25.0 72.7 27.3

4 Kanamycin 63.2 42.1 62.5 37.5 68.8 31.3

5 Amikacin 59.1 45.5 25.0 75.0 50.0 50.0

6 Gentamycin 37.5 18.8 85.7 14.3 77.8 22.2

7 Co-trimoxazole 71.4 14.3 100.0 0.0 87.5 12.5

8 Norfloxacin 150.0 37.5 80.0 20.0 58.3 41.7

9 Azithromycin 23.5 29.4 37.5 62.5 42.9 57.1

10 Nalidixic acid 66.7 33.3 100.0 0.0 75.0 25.0

120

kanamycin- 65.0%, amikacin- 65.2% and norfloxacin- 61.5%.

S. albus was 100% resistant to kanamycin, co-trimoxazole,

norfloxacin and nalidixic acid followed by azithromycin- 66.7%.

Sensitive antibiotics were ciprofloxacin- 66.7%, amikacin- 66.7%, and

ceftazidime- 60.0% while amoxicillin and gentamycin were 50.0%



Escherichia coli, Klebsiella pneumonia and Pseudomonas

aeruginosa were the organisms isolated from Pus isolates.

[Table.IV.3.f]

E. coli showed high resistance to amoxicillin- 93.8%, co-

trimoxazole- 71.4%, ciprofloxacin- 70.0%, nalidixic acid- 66.7%,

ceftazidime- 64.7%, kanamycin- 63.2%, norfloxacin- 62.5% and

amikacin- 59.1%.

K. pneumoniae was 100% resistant to co- trimoxazole and nalidixic

acid followed by gentamycin- 85.7%, norfloxacin- 80.0%, ceftazidime-

75.0%, amoxicillin- 63.6% and kanamycin- 62.5%. Sensitive antibiotic

was azithromycin- 62.5% while ciprofloxacin showed 50.0% resistance

and 50.0% sensitivity.

P. aeruginosa showed resistance to co- trimoxazole- 87.5%,

amoxicillin- 83.3%, gentamycin- 77.8%, nalidixic acid- 75.0%,

ceftazidime- 72.7%, kanamycin- 68.8% and norfloxacin- 58.3%.

Azithromycin was sensitive by 57.1% while ciprofloxacin and amikacin

were 50.0% resistant and 50.0% sensitive.

121

ANTIBIOTIC SUSCEPTIBILITY PATTERN FOR THE PRESCRIBED

ANTIBIOTICS

Public Sector

Ampicillin, ciprofloxacin, norfloxacin, ofloxacin, co- trimoxazole,

doxycycline and tetracycline were prescribed antibiotics at the public

sector [Government hospital] for various health problems.

In the study ampicillin showed 51.7% resistance and 48.3%

sensitivity, ciprofloxacin showed 29.2% sensitivity and 70.8%,

norfloxacin showed 50.0% resistance and 50.0% sensitivity, ofloxacin

showed 90.0% resistance and 10.0% sensitivity, co- trimoxazole

showed 70.0% resistance and 30.0% sensitivity and tetracycline

showed 40.3% resistance and 59.3% sensitivity. [Figure.IV.3.l]

Private sector

Ampicillin, amoxicillin, amoxicillin in combination with clavulanic

acid, penicillin, amikacin, gentamycin, ciprofloxacin, ofloxacin,

tetracycline, doxycycline and linezolid are the frequently used

antibiotics for the frequent health infections observed at the private

sector [Private hospital and retail pharmacy outlet].

Ampicillin showed 95.5% resistance and 4.5% sensitivity,

amoxicillin showed 89.4% resistance and 10.6% sensitivity,

amoxicillin in combination with clavulanic acid showed 73.7%

resistance and 26.3% sensitivity, penicillin was not used for test,

amikacin 38.1% resistance and 61.9% sensitivity, gentamycin showed

77.7% resistance and 22.3% sensitivity, ciprofloxacin showed 74.2%

122

resistance and 25.8% sensitivity, ofloxacin showed 70.7% resistance

and 29.3% sensitivity, tetracycline showed 84.4% resistance and

15.2% sensitivity and lastly linezolid showed 65.4% resistance and

34.6% sensitivity. [Figure.IV.3.l]

123

Figure.IV.3.l: Resistance and sensitivity profile of the prescribed antibiotics at the public [Government hospital]

and private sector [private hospital and retail pharmacy outlet].

84.8

40.7

58.0

70.7

90.0

77.850

65.4

77.7

66.7

95.6

70

74.2

29.2

73.7

43.4

95.5

51.7

38.1

18.5

89.431.4

15.2

59.3

42

29.3

10

22.2

50

34.6

22.333.3

4.4

30

25.870.8

26.3

56.6

4.5

48.3

61.9

81.5

10.668.6

Sensitive %Resistance %ANTIBIOTIC SUSCEPTIBILTIY

Private Public

Amoxicillin

Amikacin

Ampicillin

Amox+Clav

Ciprofloxacin

Co-Trimoxazole

Gentamycin

Linezolid

Norfloxacin

Ofloxacin

Penicillin

Tetracycline

124

IV.4.1.1.Introduction

Adhatoda vasica is a small, evergreen plant with broad, lanceolate

leaves measuring 10 to 16 centimeter in length and 5 centimeter

width. This small sub-herbaceous bush grows commonly in open

plains, especially in the lower Himalayas (up to 1300 meters above sea

level), India, Sri Lanka, Burma and Malaysia. The medicinal properties

of Adhatoda vasica, Vasa or Vasaka in Sanskrit are extensively used

for respiratory disorders such as cough, cold and asthma for over

2000 years in Ayurvedic and Unani. The leaves and roots contain

alkaloids, vasicinone, vasicinolone and vasicol, which may have a

bronchodilatory effect of the bronchii148. In general Adhatoda vasica

has the following activities:

Bronchodilatory and antiasthmatic activity

Antibacterial activity:

Antitubercular activity:

Cholagogue activity:

Antidyspepsia activity:

Abortifacient and uterotonic activity:

Wound-healing activity:

As this plant shows different activities against various health

problems the antibacterial activity of this plant was studied against

the selected organisms keeping in view the importance of traditional

medicinal plants as resistance towards antibiotics by different

organisms is on the highest percentage.

125

IV.4.1.2. Results

Root, stem and leaf of Adhatoda vasica were tested for antibacterial

activity with their respective extracts from hot water, ethanol, and

methanol and petroleum ether.

IV.4.1.2.1a. Antibacterial activity of Adhatoda vasica root by disc

diffusion method

Five different concentrations [0.5, 1.0, 1.5, 2.0, and 2.5 (mg/ml)] of

various solvents were tested against: [table.IV.4.1.2.1a]

HOT WATER


Among gram positive organisms, growth of S. aureus was not

inhibited by hot water extract of Adhatoda vasica root. While growth

of M. luteus was not inhibited at 0.5mg/ml and 1.0mg/ml

concentration, at 1.5mg/ml concentration it was 5.2mm, at 2.0mg/ml

it was 5.5mm and at 2.5mg/ml it was 5.9mm.


Growth of E. coli was also not inhibited at 0.5mg/ml and 1.0mg/ml

concentrations, at 1.5mg/ml it was 5.3mm, at 2.0mg/ml it was

5.8mm and at 2.5mg/ml it was 6.3mm. Similar to mentioned

organisms, 0.5mg/ml and 10% concentrations did not effect the

growth of P. aeruginosa, at 1.5mg/ml it was 5.1mm, at 2.0mg/ml it

was 5.3mm and at 2.5mg/ml it was 5.7mm.

126

ETHANOL





concentrations, at 1.5mg/ml concentration the zone of inhibition was

5.3mm, at 2.0mg/ml it was 5.6mm and at 2.5mg/ml it was 5.8mm.


Growth of E. coli was also not inhibited at 0.5mg/ml, 1.0mg/ml

and 1.5mg/ml concentrations, at 2.0mg/ml concentration zone of

inhibition was 5.0mm and at 2.5µg/ml it was 5.4mm. Similar to

mentioned organisms, 0.5mg/ml and 1.0mg/ml concentrations did

not effect the growth of P. aeruginosa, while at 1.5mg/ml the zone of

inhibition was 5.2mm, at 2.0mg/ml it was 5.5mm and at 2.5mg/ml it

was 5.9mm.

METHANOL





concentrations, at 1.5mg/ml concentration the zone of inhibition was



Growth of E. coli was also not inhibited at 0.5mg/ml, 1.0mg/ml and

127

1.5mg/ml concentration, at 2.0mg/ml concentration the zone of

inhibition was 5.2mm and at 2.5mg/ml it was 5.6mm. Similar to

mentioned organisms, 0.5mg/ml and 1.0mg/ml concentration did not

effect the growth of P. aeruginosa, while at 1.5mg/ml the zone of


was 5.8mm.

PETROLEUM ETHER



inhibited by hot water extract of Adhatoda vasica root. While,

growth of M. luteus was not inhibited at 0.5mg/ml and 1.0mg/ml

concentration, at 1.5mg/ml concentration, the zone of inhibition was



E. coli and P. aeruginosa were not inhibited at any concentrations.

128

Table.IV.4.1.2.1a: Antibacterial activity of Adhatoda vasica root

[Mean zone of inhibition was represented in mm with standard error]

Extract Concentration (mg/ml)

S. aureus M. luteus E. coli P. aeruginosa

Hot Water

0.5 - - - -

1.0 - - - -

1.5 - 5.2 ± 0.05 5.3 ± 0.08 5.1 ± 0.07

2.0 - 5.5 ± 0.07 5.8 ± 0.06 5.3 ± 0.08

2.5 - 5.9 ± 0.04 6.3 ± 0.11 5.7 ± 0.12

Ethanol

0.5 - - - -

1.0 - - - -

1.5 - 5.3 ± 0.05 - 5.2 ± 0.05

2.0 - 5.6 ± 0.08 5.0 ± 0.09 5.5 ± 0.06

2.5 - 5.8 ± 0.10 5.4 ± 0.12 5.9 ± 0.09

Methanol

0.5 - - - -

1.0 - - - -

1.5 - 5.0 ± 0.09 - 5.3 ± 0.07

2.0 - 5.3 ± 0.07 5.2 ± 0.10 5.5 ± 0.08

2.5 - 5.5 ± 0.10 5.6 ± 0.11 5.8 ± 0.09

Petroleum Ether

0.5 - - - -

1.0 - - - -

1.5 - 5.2 ± 0.05 - -

2.0 - 5.5 ± 0.06 - -

2.5 - 5.9 ± 0.08 - -

129

IV.4.1.2.1b. Antibacterial activity of Adhatoda vasica root by

minimum inhibitory concentration [MIC]

Table.IV.4.1.2.1b: Minimum Inhibitory Concentration [MIC] value of

Adhatoda vasica root extract against the bacteria by 2-fold serial

dilution assay [Figures are in µg/ml].

Solvents S. aureus M. luteus E. coli P. aeruginosa

Hot water - 200 200 300

Ethanol - 375 375 200

Methanol - 250 300 75

Petroleum Ether - 175 - -

In hot water, S. aureus has no MIC value, where as M. luteus,

E. coli and P. aeruginosa and has 200µg/ml, 200µg/ml and 300µg/ml

respectively.

In ethanol, S. aureus has no MIC value, where as M. luteus, E. coli

and P. aeruginosa and has 375µg/ml, 375µg/ml and 200µg/ml

respectively.

In methanol, S. aureus has no MIC value, where as M. luteus,


respectively.

In petroleum ether, S. aureus, E. coli and P. aeruginosa has no MIC

value, where as M. luteus has 175µg/ml.

130

IV.4.1.2.2a. Antibacterial activity of Adhatoda vasica stem by

disc diffusion method



HOT WATER



inhibited by hot water extract of Adhatoda vasica stem. While growth

of M. luteus was not inhibited at 0.5mg/ml concentration but from

concentration 1.0mg/ml, the zone of inhibition was 5.2mm, at

1.5mg/ml it was 5.5mm, at 2.0mg/ml it was 5.8cm and at 2.5mg/ml

it was 6.0mm.


Growth of E. coli was also not inhibited at 0.5mg/ml concentration

and at 1.0mg/ml the zone of inhibition was 5.4mm, at 1.5mg/ml it

was 5.9mm, at 2.0mg/ml it was 6.1cm and at 2.5mg/ml it was

6.4mm. Similar to mentioned organisms, 0.5mg/ml concentration did


inhibition was 5.3mm, at 1.5mg/ml it was 5.6cm, at 2.0mg/ml it was

5.9mm and at 2.5mg/ml it was 6.1mm.

ETHANOL



inhibited by ethanol extract of Adhatoda vasica stem. While growth of

131

M. luteus was not inhibited at 0.5mg/ml concentration but from


1.5mg/ml it was 5.5mm, at 2.0mg/ml it was 5.8mm and at 2.5mg/ml

it was 6.0mm.



concentration, at 1.5mg/ml it was 5.0mm, at 2.0mg/ml it was 5.3mm

and at 2.5mg/ml it was 5.7mm. Similar to mentioned organisms,

0.5mg/ml concentration did not effect the growth of P. aeruginosa,

while at 1.0mg/ml the zone of inhibition was 5.3mm, at 1.5mg/ml it

was 5.7mm, at 2.0mg/ml it was 5.9cm and at 2.5mg/ml it was

6.2mm.

METHANOL






and at 2.5mg/ml it was 5.6mm.



concentration, at1.5mg/ml it was 5.0mm, at 2.0mg/ml it was 5.4mm

and at 2.5mg/ml it was 5.8mm. Growth of P. aeruginosa was inhibited

at 0.5mg/ml concentration with 5.0mm zone of inhibition, while at

132

1.0mg/ml the zone of inhibition was 5.2mm, at 1.5mg/ml it was


PETROLEUM ETHER







133

Table.IV.4.1.2.2a: Antibacterial activity of Adhatoda vasica stem.


Extract Concentration

(mg/ml) S. aureus M. luteus E. coli P. aeruginosa

Hot Water

0.5 - - - -

1.0 - 5.2 ± 0.06 5.4 ± 0.06 5.3 ± 0.05

1.5 - 5.5 ± 0.07 5.9 ± 0.07 5.6 ± 0.06

2.0 - 5.8 ± 0.10 6.1 ± 0.09 5.9 ± 0.09

2.5 - 6.0 ± 0.09 6.4 ± 0.11 6.1 ± 0.10

Ethanol

0.5 - - - -

1.0 - 5.2 ± 0.12 - 5.3 ± 0.13

1.5 - 5.5 ± 0.13 5.0 ± 0.10 5.7 ± 0.14

2.0 - 5.8 ± 0.16 5.3 ± 0.12 5.9 ± 0.15

2.5 - 6.0 ± 0.14 5.7 ± 0.13 6.2 ± 0.16

Methanol

0.5 - - - 5.0 ± 0.06

1.0 - - - 5.2 ± 0.06

1.5 - 5.2 ± 0.05 5.0 ± 0.09 5.5 ± 0.07

2.0 - 5.2 ± 0.05 5.4 ± 0.08 5.8 ± 0.07

2.5 - 5.6 ± 0.07 5.8 ± 0.11 6.0 ± 0.08

Petroleum Ether

0.5 - - - -

1.0 - - - -

1.5 - 5.0 ± 0.06 - -

2.0 - 5.2 ± 0.05 - -

2.5 - 6.0 ± 0.10 - -

134

IV.4.1.2.2b. Antibacterial activity of Adhatoda vasica stem by



Adhatoda vasica stem extract against the bacteria by 2-fold serial


Organisms S. aureus M. luteus E. coli P. aeruginosa

Hot water - 175 175 150

Ethanol - 175 200 150

Methanol - 175 200 200


In hot water, S. aureus has no MIC value, where as M. luteus,


respectively.

In ethanol, S. aureus has no MIC value, where as M. luteus, E. coli

and P. aeruginosa and has 175µg/ml, 200µg/ml and 150µg/ml

respectively.

In methanol, S. aureus has no MIC value, where as M. luteus,


respectively.

In petroleum ether, S. aureus, E. coli and P. aeruginosa has no MIC

value, where as M. luteus has 200µg/ml.

135

IV.4.1.2.3a. Antibacterial activity of Adhatoda vasica leaf by disc

diffusion method



HOT WATER



inhibited by hot water extract of Adhatoda vasica leaf. While growth of



1.5mg/ml it was 5.5mm, at 20mg/ml it was 5.7mm and at 2.5mg/ml

it was 6.0mm.



concentration, at 1.5mg/ml the zone of inhibition was 5.3mm, at

2.0mg/ml it was 5.7mm and at 2.5mg/ml it was 6.2mm. Similar to

mentioned organisms, 0.5mg/ml concentration did not effect the

growth of P. aeruginosa, while at 1.0mg/ml the zone of inhibition was

5.0mm, at 1.5mg/ml it was 5.2mm, at 2.0mg/ml it was 5.6mm and at

2.5mg/ml it was 5.8mm.

ETHANOL




136


concentration 1.0mg/ml, the zone of inhibition was 5.2cm, at


it was 5.8mm.




was 5.4mm, at 2.0mg/ml it was 5.8mm and at 2.5mg/ml it was



inhibition was 5.3cm, at 1.5mg/ml it was 5.5mm, at 2.0mg/ml it was


METHANOL




M. luteus was not inhibited at 0.5mg/ml and 1.0mg/ml concentration,

at 1.5mg/ml concentration the zone of inhibition it was 5.3mm, at

2.0mg/ml it was 5.5mm and at 2.5mg/ml it was 5.8mm.


Growth of E. coli was inhibited from 0.5mg/ml concentration with a

zone of inhibition 5.2mm, at 1.0mg/ml the zone of inhibition was


25mg/ml it was 6.3mm. Similarly P. aeruginosa was also inhibited

137

from 0.5mg/ml concentration with a zone of inhibition of 5.1mm, at

1.0mg/ml concentration it was 5.3mm, while at 1.5mg/ml the zone of


was 6.1mm.

PETROLEUM ETHER





at 1.5mg/ml concentration the zone of inhibition was 5.2mm, at




1.5mg/ml concentrations, at 2.0mg/ml concentration the zone of

inhibition was 5.2mm and at 2.5mg/ml it was 5.4mm. Similar to

mentioned organisms, 0.5mg/ml, 1.0mg/ml and 1.5mg/ml

concentration did not effect the growth of P. aeruginosa, while at

2.0mg/ml the zone of inhibition was 5.0mm and at 2.5mg/ml it was

5.3mm.

138

Table.IV.1.2.3a: Antibacterial activity of Adhatoda vasica leaf.




Hot Water

0.5 - - - -

1.0 - 5.3 ± 0.06 - 5.0 ± 0.04

1.5 - 5.5 ± 0.09 5.3 ± 0.03 5.2 ± 0.04

2.0 - 5.7 ± 0.07 5.7 ± 0.05 5.6 ± 0.05

2.5 - 6.0 ± 0.07 6.2 ± 0.05 5.8 ± 0.09

Ethanol

0.5 - - - -

1.0 - 5.2 ± 0.07 5.2 ± 0.05 5.3 ± 0.08

1.5 - 5.4 ± 0.07 5.4 ± 0.07 5.5 ± 0.08

2.0 - 5.6 ± 0.10 5.8 ± 0.07 5.9 ± 0.09

2.5 - 5.8 ± 0.08 6.2 ± 0.10 6.3 ± 0.10

Methanol

0.5 - - 5.2 ± 0.8 5.1 ± 0.09

1.0 - - 5.5 ± 0.07 5.3 ± 0.08

1.5 - 5.3 ± 0.07 5.7 ± 0.08 5.6 ± 0.08

2.0 - 5.5 ± 0.08 5.9 ± 0.09 5.8 ± 0.08

2.5 - 5.8 ± 0.08 6.3 ± 0.09 6.1 ± 0.11

Petroleum

Ether

0.5 - - - -

1.0 - - - -

1.5 - 5.2 ± 0.06 - -

2.0 - 5.4 ± 0.10 5.2 ± 0.07 5.0 ± 0.09

2.5 - 5.7 ± 0.12 5.4 ± 0.08 5.3 ± 0.09

139

IV.4.1.2.3b. Antibacterial activity of Adhatoda vasica leaf by


Table.IV.4.1.2.3b: Minimum Inhibitory concentration [MIC] value of

Adhatoda vasica leaf against the bacteria by 2-fold serial dilution

assay [Figures in µg/ml].


Hot water 725 200 150 175

Ethanol 600 75 75 200

Methanol 650 100 50 75

Petroleum Ether 825 150 175 275

In hot water S. aureus has 725µg/ml and M. luteus has 200µg/ml

where as E. coli and P. aeruginosa has 150µg/ml and 175µg/ml

respectively.

In ethanol, S. aureus has 600µg/ml and M. luteus has 75µg/ml

where as E. coli has 75µg/ml and P. aeruginosa has 200µg/ml.

In methanol, S. aureus has 650µg/ml and M. luteus has 100µg/ml

where as E. coli has 50µg/ml and P. aeruginosa has 75µg/ml.

In petroleum ether, S. aureus has 825µg/ml and M. luteus has

150µg/ml where as E. coli has 175µg/ml and P. aeruginosa has

275µg/ml.

140

IV.4.2.1. INTRODUCTION

Aegle marmelos correa ex Roxb. , commonly known as Bael tree, is a

deciduous tree, 7-8 m in height with trifoliate aromatic leaves and

bisexual flowers, indigenous to India, Myanmar and Srilanka, often

planted in the vicinity of Shiva temples. It is commonly found in the

sub- Himalayan tract up to an altitude of 1200m. Bark, flower, fruit,

leaf, root and stem are all used in the treatments of many ailments

especially diarrhea, tuberculosis, wound healing properties etc. Major

chemical constituents were alkaloids- aegelenine and aegeline,

anthraquinones, coumarins, tannins and triterpenes which had the

medicinal activity. In general Aegle marmelos has the following

medicinal and pharmacological activities:

Antiulcer activity

Antimicrobial activity

Hypoglycemic activity

Anti- diarrheal activity – Irritable Bowel Syndrome

Anti-inflammatory activity

In view of the above information and knowledge from traditional

practioners, the root, stem and leaves are evaluated for antibacterial

activity on the selected organisms to overcome the resistance problem

and encourage the medicinal plant usage.

141

IV.4.2.2. RESULTS

IV.4.2.2.1a. Antibacterial activity of Aegle marmelosa root by





Gram Negative organisms

HOT WATER


Among gram positive organisms, growth of S.aureus was not

inhibited at 0.5mg/ml and 1.0mg/ml concentration of hot water

extract of Aegle marmelosa root, but 1.5mg/ml showed a zone of

inhibition of 5.2mm, at 2.0mg/ml it was 5.5mm and at 2.5 mg/ml it

was 5.8mm. While growth of M. luteus was not inhibited at 0.5mg/ml

concentration but from concentration 1.0mg/ml, the zone of inhibition

was 5.1mm, at 1.5mg/ml it was 5.3mm, at 2.0mg/ml it was 5.4mm






6.0mm. Similar to mentioned organisms, 0.5mg/ml and 1.0mg/ml




142

ETHANOL



inhibited at 0.5mg/ml, 1.0mg/ml and 1.5mg/ml concentrations of hot

water extract of Aegle marmelosa root, at 2.0mg/ml concentration the

zone of inhibition was 5.1mm and at 2.5mg/ml it was 5.4mm. While

growth of M. luteus was not inhibited at 0.5mg/ml and 1.0mg/ml

concentration, at 1.5mg/ml concentration the zone of inhibition was

5.1mm, at 2.0mg/ml it was 5.3cm and at 2.5mg/ml it was 5.8mm.



1.5mg/ml concentration and at 2.0mg/ml the zone of inhibition was

5.2mm and at 2.5mg/ml it was 5.6mm. Similar to mentioned

organisms, 0.5mg/ml concentration did not effect the growth of P.

aeruginosa, while at 1.0mg/ml the zone of inhibition was 5.2mm, at


it was 5.9mm.

METHANOL



inhibited by hot water extract of Aegle marmelosa root. While growth

of M. luteus was not inhibited at 0.5mg/ml concentration, at

1.0mg/ml concentration the zone of inhibition was 5.1mm, at


it was 6.0mm.

143





at 0.5mg/ml concentration with a zone of inhibition of 5.2mm, at



PETROLEUM ETHER



inhibited by hot water extract of Aegle marmelos root. While growth of

M. luteus was inhibited at 0.5mg/ml concentration with zone of

inhibition 5.1mm, at 1.0mg/ml the zone of inhibition was 5.3mm, at

1.5mg/ml it was 5.6mm, at 2.0mg/ml it was 5.8cm and at 2.5mg/ml

it was 6.1mm.


Growth of E. coli was inhibited at 0.5mg/ml concentration with

5.2mm and at 1.0mg/ml the zone of inhibition was 5.5mm, at


it was 6.2mm. Similar to mentioned organisms, 0.5mg/ml

concentration showed 5.1mm zone of inhibition, while at 1.0mg/ml

the zone of inhibition was 5.3cm, at 1.5mg/ml it was 5.8mm, at

2.0mg/ml it was 6.1mm and at 2.5mg/ml it was 6.3cm.

144

Table.IV.2.2.1a: Antibacterial activity of Aegle marmelos root




Hot Water

0.5 - - - -

1.0 - 5.1 ± 0.09 5.1 ± 0.06 -

1.5 5.2 ± 0.08 5.3 ± 0.10 5.4 ± 0.07 5.1 ± 0.06

2.0 5.5 ± 0.07 5.4 ± 0.10 5.8 ± 0.07 5.4 ± 0.08

2.5 5.8 ± 0.09 6.2 ± 0.07 6.0 ± 0.10 5.8 ± 0.09

Ethanol

0.5 - - - -

1.0 - - - 5.2 ± 0.05

1.5 - 5.1 ± 0.09 - 5.3 ± 0.06

2.0 5.1 ± 0.07 5.3 ± 0.09 5.2 ± 0.05 5.7 ± 0.06

2.5 5.4 ± 0.08 5.8 ± 0.06 5.6 ± 0.06 5.9 ± 0.06

Methanol

0.5 - - - 5.2 ± 0.05

1.0 - 5.1 ± 0.06 - 5.5 ± 0.08

1.5 - 5.4 ± 0.08 5.1 ± 0.06 5.7 ± 0.08

2.0 - 5.8 ±0.07 5.5 ± 0.08 6.1 ±0.07

2.5 - 6.0 ± 0.05 5.9 ± 0.08 6.4 ± 0.09

Petroleum

Ether

0.5 - 5.1 ± 0.06 5.2 ± 0.04 5.1 ± 0.04

1.0 - 5.3 ± 0.05 5.5 ± 0.05 5.3 ± 0.05

1.5 - 5.6 ± 0.08 5.7 ± 0.05 5.8 ± 0.06

2.0 - 5.8 ± 0.08 6.0 ±0.03 6.1 ± 0.06

2.5 - 6.1 ± 0.07 6.2 ± 0.07 6.3 ±0.07

145

IV.4.2.2.1b. Antibacterial activity of Aegle marmelosa root by


Table.IV.2.2.1b: Minimum Inhibitory Concentration [MIC] value of

Aegle marmelos root extract against the bacteria by 2 fold serial

dilution assay [figures in µg/ml].


Hot water 275 200 100 300

Ethanol 375 300 375 200

Methanol - 200 300 75

Petroleum Ether - 100 75 100


where as E. coli has 100µg/ml and P. aeruginosa has and 300µg/ml.


where as E. coli have 375µg/ml and P. aeruginosa 200µg/ml.

In methanol, S. aureus has no inhibition and M. luteus has


75µg/ml.

In petroleum ether, S. aureus has no inhibition and M. luteus has


100µg/ml.

146

IV.4.2.2.2a. Antibacterial activity of Aegle marmelosa stem by






HOT WATER

I. Gram positive organisms


inhibited by hot water extract of Aegle marmelos stem. While growth of




it was 5.9mm.

II. Gram negative organisms




6.3mm. Similar to mentioned organisms, 0.05mg/ml concentration

did not effect the growth of P. aeruginosa, while at 1.0mg/ml the zone

of inhibition was 5.2mm, at 1.5mg/ml it was 5.5mm, at 2.0mg/ml it

was 5.8mm and at 2.5mg/ml it was 6.0mm.

147

ETHANOL







it was 6.2mm.


Growth of E. coli was also not inhibited at 0.5mg/ml and

1.0mg/ml concentration, at 1.5mg/ml it was 5.2mm, at 2.0mg/ml it

was 5.5mm and at 2.5mg/ml it was 5.9mm. Similar to mentioned

organisms, 0.5mg/ml concentration did not effect the growth of

P. aeruginosa, while at 1.0mg/ml the zone of inhibition was 5.5mm, at


it was 6.3mm.

METHANOL





at 1.5mg/ml it was 5.1mm, at 2.0mg/ml it was 5.3mm and at

2.5mg/ml it was 5.7mm.

148





at 0.5mg/ml concentration with zone of inhibition of 5.1mm, while at



PETROLEUM ETHER







it was 6.1mm.


E. coli and P. aeruginosa were not inhibited by any concentrations of

petroleum ether extract of Aegle marmelosa.

149

Table.IV.2.2.2a: Antibacterial activity of Aegle marmelos stem.




Hot Water

0.5 - - - -

1.0 - 5.1 ± 0.05 5.3 ± 0.03 5.2 ± 0.06

1.5 - 5.4 ± 0.06 5.8 ± 0.05 5.5 ± 0.07

2.0 - 5.7 ± 0.08 6.0 ± 0.07 5.8 ±0.07

2.5 - 5.9 ± 0.09 6.3 ±0.08 6.0 ± 0.07

Ethanol

0.5 - - - -

1.0 - 5.4 ± 0.06 - 5.5 ± 0.07

1.5 - 5.7 ± 0.08 5.2 ± 0.06 5.9 ± 0.06

2.0 - 6.0 ± 0.08 5.5 ± 0.06 6.1 ± 0.08

2.5 - 6.2 ± 0.08 5.9 ± 0.07 6.3 ± 0.08

Methanol

0.5 - - - 5.1 ± 0.07

1.0 - - - 5.3 ± 0.08

1.5 - 5.1 ± 0.08 5.1 ± 0.07 5.6 ± 0.08

2.0 - 5.3 ± 0.08 5.5 ± 0.08 5.9 ± 0.06

2.5 - 5.7 ± 0.08 5.9 ± 0.08 6.1 ± 0.08

Petroleum

Ether

0.5 - - - -

1.0 - 5.1± 0.07 - -

1.5 - 5.3 ± 0.07 - -

2.0 - 5.9 ± 0.09 - -

2.5 - 6.1 ± 0.08 - -

150

IV.4.2.2.2b. Antibacterial activity of Aegle marmelosa stem by


Table.IV.4.1.2.2b: Minimum Inhibitory concentration [MIC] value of

Aegle marmelosa stem against the bacteria by 2-fold serial dilution

assay [Figures in µg/ml].


Hot water - 200 150 175

Ethanol - 100 375 75

Methanol - 300 300 100


In hot water S. aureus has no MIC value and M. luteus has

200µg/ml where as E. coli and P. aeruginosa has 150µg/ml and

175µg/ml.

In ethanol, S. aureus has no MIC value and M. luteus has


75µg/ml.

In methanol, S. aureus has no inhibition and M. luteus has


100µg/ml.

In petroleum ether, S. aureus, E. coli and P. aeruginosa has no

inhibition and M. luteus has at 200µg/ml.

151

IV.4.2.2.3a. Antibacterial activity of Aegle marmelosa leaf by disc

diffusion method





HOT WATER



inhibited at 0.5mg/ml concentration of hot water extract of Aegle

marmelos leaf, but at 1.0mg/ml the zone of inhibition was 5.3mm, at

1.5mg/ml it was 5.8mm, at 2.0mg/ml it was 6.2mm and 2.5mg/ml it

was 6.4mm. While growth of M. luteus was not inhibited at 0.5mg/ml

and 1.0mg/ml concentration, at 1.5mg/ml it was 5.4mm, at








inhibition was 5.3mm, at 1.5mg/ml it was 6.4m, at 2.0mg/ml it was


152

ETHANOL



inhibited at 0.5mg/ml concentration of hot water extract of Aegle

marmelos leaf, but at 1.0mg/ml the zone of inhibition was 5.4mm, at

1.5mg/ml it was 6.0mm, at 2.0mg/ml it was 6.7mm and 2.5mg/ml it

was 7.2mm. While growth of M. luteus was inhibited at 0.5mg/ml

concentration with a zone of inhibition of 5.2mm, at 1.0mg/ml, the

zone of inhibition was 5.6mm, at 1.5mg/ml it was 5.8mm, at



Growth of E. coli was also not inhibited at 0.05mg/ml

concentration and at 1.0mg/ml the zone of inhibition was 5.3mm, at


it was 7.2mm. Similarly, 0.5mg/ml and 1.0mg/ml concentration did



was 6.1mm.

METHANOL



inhibited at 0.5mg/ml and 1.0mg/ml concentrations of hot water

extract of Aegle marmelos leaf, but at 1.5mg/ml the zone of inhibition

was 5.3mm, at 2.0mg/ml it was 5.5mm and 2.5mg/ml it was 6.0mm.

153

While growth of M. luteus was inhibited at 0.5mg/ml concentration

with 5.2mm zone of inhibition, at 1.0mg/ml the zone of inhibition was


2.5µg/ml it was 7.0mm.



5.2mm zone of inhibition and at 1.0mg/ml the zone of inhibition was


2.5mg/ml it was 6.9mm. Similar to mentioned organisms, 0.5mg/ml

concentration inhibited the growth of P. aeruginosa at 5.3mm, while at



PETROLEUM ETHER


Among gram positive organisms, growth of S. aureus was inhibited

by hot water extract of Aegle marmelos leaf at1.5mg/ml concentration

with 5.3mm zone of inhibition, at 2.0mg/ml it was 6.2mm and at

2.5mg/ml it was 6.2mm. While growth of M. luteus was not inhibited

at 0.5mg/ml concentration but from concentration 1.0mg/ml, the

zone of inhibition was 5.2mm, at 1.5mg/ml it was 5.4mm, at





154


6.7mm. Similar to mentioned organisms, 0.5mg/ml and 1.0mg/ml




155

Table.IV.2.2.3a: Antibacterial activity of Aegle marmelos leaf.




Hot Water

0.5 - - - -

1.0 5.3 ± 0.06 - 5.2 ± 0.07 5.3 ± 0.05

1.5 5.8 ± 0.07 5.4 ± 0.09 6.1 ± 0.08 6.4 ± 0.06

2.0 6.2 ± 0.07 6.5 ± 0.08 6.3 ± 0.06 6.5 ± 0.05

2.5 6.4 ± 0.08 7.2 ± 0.07 7.0 ± 0.09 6.8 ± 0.04

Ethanol

0.5 - 5.2 ± 0.06 - -

1.0 5.4 ± 0.05 5.6 ± 0.05 5.3 ± 0.06 -

1.5 6.0 ± 0.06 5.8 ±0.04 5.8 ± 0.05 5.4 ± 0.07

2.0 6.7 ± 0.07 6.2 ± 0.04 6.0 ± 0.07 5.7 ± 0.05

2.5 7.2 ± 0.08 6.9 ± 0.07 7.2 ± 0.08 6.1 ± 0.06

Methanol

0.5 - 5.2 ± 0.06 5.2 ± 0.09 5.3 ± 0.06

1.0 - 5.6 ± 0.05 5.5 ± 0.05 5.5 ± 0.08

1.5 5.3 ± 0.06 6.2 ± 0.04 5.8 ± 0.08 6.1 ± 0.06

2.0 5.5 ± 0.07 6.6 ± 0.06 6.2 ± 0.07 6.9 ± 0.08

2.5 6.0 ± 0.07 7.0 ± 0.05 6.9 ± 0.08 7.2 ± 0.05

Petroleum

Ether

0.5 - - - -

1.0 - 5.2 ± 0.07 5.2 ± 0.05 -

1.5 5.3 ± 0.08 5.4 ± 0.09 5.8 ± 0.06 5.2 ± 0.05

2.0 6.2 ± 0.08 6.2 ± 0.09 6.7 ± 0.07 6.0 ± 0.08

2.5 6.2 ± 0.09 6.2 ± 0.10 6.7 ± 0.07 6.0 ± 0.06

156


Aegle marmelosa leaf extract against the bacteria by 2 fold serial



Hot water 150 225 175 150

Ethanol 125 75 100 225

Methanol 250 75 50 50



where as E. coli and P. aeruginosa has 175µg/ml and 150µg/ml.





In petroleum ether, S. aureus has 250µg/ml and M. luteus has at

175µg/ml, E. coli 150µg/ml and P. aeruginosa has 275µg/ml.

157

IV.4.3.1. INTRODUCTION

Ziziphus oenoplia is a spreading thorny grows up to 1.5 meter in

height, leaves simple, alternate, ovate- lanceolate, acute oblique,

flowers green, in sub sessile auxillary cymes. It grows wildly

throughout India on different plains.

It is commonly called Jackal Jujube and in Sanskrit it is called

karkandhauh and in Telugu it is called paraki or paragi.

The medicinal uses of Z. oenoplia are:

Anthelmintic

Hyperacidity

Peptic ulcers

Wound healing activity

In view of the above information and knowledge, the root, stem and

leaves are evaluated for antibacterial activity on the selected

organisms to overcome the resistance problem and encourage the

medicinal plant usage.

158

IV.4.3.2. RESULTS

IV.4.3.2.1a. Antibacterial activity of Ziziphus oenoplia root by






HOT WATER



inhibited at 0.5mg/ml and 1.0mg/ml concentration, at 1.5mg/ml the

zone of inhibition was 9.2mm, at 2.0mg/ml the zone of inhibition was

9.4mm and at 2.5mg/ml it was 9.7mm. While growth of M. luteus was

not inhibited at 0.5mg/ml and 1.0mg/ml concentration, at 1.5mg/ml

it was 6.4mm, at 2.0mg/ml it was 6.8mm and at 2.5mg/ml it was

7.2mm.







inhibition was 8.3mm, at 1.5mg/ml it was 8.5mm, at 2.0mg/ml it was


159

ETHANOL



inhibited at 0.5mg/ml concentration while at 1.0mg/ml the zone of

inhibition was 10.1mm, at 1.5mg/ml it was 10.3mm, at 2.0mg/ml it

was 10.5mm and at 2.5mg/ml it was 10.7mm. M. luteus was not

inhibited at 0.5mg/ml concentration but from concentration 1.0

mg/ml, the zone of inhibition was 6.0mm, at 1.5mg/ml it was 6.2mm,

at 2.0mg/ml it was 6.3mm and at 2.5µg/ml it was 6.4mm.



concentration, at 1.5mg/ml concentration it was 8.1mm, at 2.0mg/ml

it was 8.3mm and at 2.5mg/ml it was 8.5mm. P. aeruginosa was not

inhibited at any concentrations of ethanol extract.

METHANOL


Among gram positive organisms, growth of S. aureus was inhibited

at 0.5mg/ml and 1.0mg/ml concentration, while at 1.5mg/ml

concentration the zone of inhibition was 10.2mm, at 2.0mg/ml it was

10.5mm and at 2.5mg/ml it was 10.6mm, While growth of M. luteus

was not inhibited at 0.5mg/ml concentration but from concentration

1.0mg/ml, the zone of inhibition was 6.0mm, at 1.5mg/ml it was


160



8.3mm zone of inhibition, at 1.0mg/ml the zone of inhibition was


2.5mg/ml it was 9.2mm. P. aeruginosa was not inhibited at any

concentrations of methanol extract.

PETROLEUM ETHER



inhibited at 0.5mg/ml and 1.0mg/ml concentration, at 1.5mg/ml

concentration the zone of inhibition was 6.0mm, at 2.0mg/ml it was

6.2mm and at 2.5mg/ml it was 6.2mm. While growth of M. luteus was

not inhibited at 0.5mg/ml concentration but from concentration





and 1.5mg/ml concentrations, at 2.0mg/ml it was 8.5mm and at

2.5mg/ml it was 8.6mm. Growth of P. aeruginosa was not inhibited at

0.5mg/ml and 1.0mg/ml concentrations, while at 1.5mg/ml the zone

of inhibition was 6.7mm, at 2.0mg/ml it was 6.9mm and at 2.5mg/ml

it was 7.0mm.

161

Table.IV.3.2.1a: Antibacterial activity of Ziziphus oenoplia root.



[µg/ml] S. aureus M. luteus E. coli P. aeruginosa

Hot Water

0.5 - - - -

1.0 - - 6.2 ± 0.08 8.3 ± 0.05

1.5 9.2 ± 0.10 6.4 ± 0.09 6.4 ± 0.09 8.5 ± 0.06

2.0 9.4 ± 0.12 6.8 ± 0.10 6.7 ± 0.11 8.8 ± 0.11

2.5 9.7 ± 0.13 7.2 ± 0.13 7.3 ± 0.10 9.1 ± 0.13

Ethanol

0.5 - - - -

1.0 10.1 ± 0.09 6.0 ± 0.05 - -

1.5 10.3 ± 0.09 6.2 ± 0.06 8.1 ± 0.04 -

2.0 10.5 ± 0.10 6.3 ± 0.07 8.3 ± 0.05 -

2.5 10.7 ± 0.08 6.4 ± 0.06 8.5 ± 0.07 -

Methanol

0.5 - - 8.3 ± 0.09 -

1.0 - 6.0 ± 0.04 8.5 ±0.03 -

1.5 10.2 ± 0.05 6.2 ± 0.05 8.7 ± 0.05 -

2.0 10.5 ± 0.06 6.3 ± 0.05 8.9 ± 0.09 -

2.5 10.6 ± 0.08 6.8 ± 0.06 9.2 ± 0.13 -

Petroleum

Ether

0.5 - - - -

1.0 - 5.2 ± 0.07 - -

1.5 6.0 ± 0.04 5.4 ± 0.08 - 6.7 ± 0.05

2.0 6.2 ± 0.06 6.2 ± 0.08 8.5 ± 0.14 6.9 ± 0.07

2.5 6.2 ± 0.07 6.2 ± 0.07 8.6 ± 0.17 7.0 ± 0.06


Ziziphus oenoplia root extract against the bacteria by 2 fold serial

dilution assay [Figures are expressed µg/ml].


Hot water 250 375 175 325

Ethanol 300 400 425 550

Methanol 250 450 400 500










163

IV.4.3.2.2a. Antibacterial activity of Ziziphus oenoplia stem by






HOT WATER


Growth of S. aureus was not inhibited at 0.5mg/ml, while at

1.0mg/ml concentration 5.2mm zone of inhibition was observed, at


it was 5.9mm. While growth of M. luteus was not inhibited at

0.5mg/ml and 1.0mg/ml concentration but from concentration






and at 2.5mg/ml it was 5.7mm. 0.5mg/ml and 1.0mg/ml




ETHANOL


164


inhibited at 0.5mg/ml concentration while at 1.0mg/ml concentration

the zone of inhibition was 8.6mm, at 1.5mg/ml it was 8.9mm, at

2.0mg/ml it was 9.1mm and at 2.5mg/ml it was 9.3mm. Growth of

M. luteus was inhibited at 0.5mg/ml concentration with a zone of

inhibition 9.2mm, at 1.0mg/ml concentration the zone of inhibition

was 9.6mm, at 1.5mg/ml it was 10.1mm, at 2.0mg/ml it was 10.3mm



Growth of E. coli was not inhibited at 0.5mg/ml concentration and

at 1.0mg/ml the zone of inhibition was 8.2mm, at 1.5mg/ml it was


P. aeruginosa was not inhibited at any of the concentrations of ethanol

extract.

METHANOL



inhibited at 0.5mg/ml concentration while at 1.0mg/ml concentration

the zone of inhibition was 11.3mm, at 1.5mg/ml it was 11.5mm, at

2.0mg/ml it was 11.8mm and at 2.5mg/ml it was 12.2mm. While the

growth of M. luteus was inhibited at 0.5mg/ml concentration with

9.8mm zone of inhibition, at 1.0mg/ml, the zone of inhibition was

10.2mm, at 1.5mg/ml it was 10.5mm, at 2.0mg/ml it was 10.8mm


165


Growth of E. coli was not inhibited at 0.5mg/ml concentration and at


10.3mm, at 2.0mg/ml it was 10.6mm and at 2.5mg/ml it was

10.8mm. Growth of P. aeruginosa was not inhibited at any

concentrations of methanol extract.

PETROLEUM ETHER



inhibited at 0.5mg/ml, 1.0mg/ml and 1.5mg/ml concentrations while

at 2.0mg/ml concentration the zone of inhibition was 7.2mm and at

2.5mg/ml it was 7.4mm. While growth of M. luteus was not inhibited

at any concentration of petroleum extract of Z. oenoplia stem.



and 1.5mg/ml concentration, at 2.0mg/ml concentration the zone of

inhibition was 7.1mm and at 2.5mg/ml it was 7.4mm, while

P. aeruginosa was not inhibited at 0.5mg/ml and 1.0mg/ml

concentration, at 1.5mg/ml the zone of inhibition was 6.1mm, at


166

Table.IV.3.2.2a: Antibacterial activity of Ziziphus oenoplia stem.



[µg/ml] S. aureus M. luteus E. coli

P.

aeruginosa

Hot Water

0.5 - - - -

1.0 5.2 ± 0.06 - - -

1.5 5.3 ± 0.07 8.1 ± 0.05 5.2 ± 0.07 7.5 ± 0.07

2.0 5.7 ± 0.09 8.4 ± 0.06 5.3 ± 0.09 7.7 ± 0.07

2.5 5.9 ± 0.07 8.9 ± 0.07 5.7 ± 0.08 8.3 ± 0.06

Ethanol

0.5 - 9.2 ± 0.08 - -

1.0 8.6 ± 0.09 9.6 ± 0.08 8.2 ± 0.06 -

1.5 8.9 ± 0.08 10.1 ± 0.06 8.4 ± 0.08 -

2.0 9.1 ± 0.08 10.3 ± 0.09 8.5 ± 0.07 -

2.5 9.3 ± 0.08 10.5 ± 0.07 8.8 ± 0.09 -

Methanol

0.5 - 9.8 ± 0.05 - -

1.0 11.3 ± 0.08 10.2 ± 0.08 10.1 ± 0.07 -

1.5 11.5 ± 0.09 10.5 ± 0.06 10.3 ± 0.07 -

2.0 11.8 ± 0.09 10.8 ± 0.08 10.6 ± 0.09 -

2.5 12.1 ± 0.07 11.2 ± 0.08 10.8 ± 0.06 -

Petroleum

Ether

0.5 - - - -

1.0 - - - -

1.5 - - - 6.1 ± 0.04

2.0 7.2 ± 0.05 - 7.1 ± 0.07 6.4 ± 0.03

2.5 7.4 ± 0.06 - 7.4 ± 0.05 6.7 ± 0.06

167

IV.4.3.2.2b. Antibacterial activity of Ziziphus oenoplia stem by



Ziziphus oenoplia stem extract against the bacteria by 2 fold serial

dilution assay [Figures are expressed in µg/ml].


Hot water 275 300 200 325

Ethanol 400 375 350 375

Methanol 325 400 375 275


In hot water S. aureus has 275µg/ml and M. luteus has300µg/ml








168

IV.4.3.2.3a. Antibacterial activity of Ziziphus oenoplia leaf by






HOT WATER


Among gram positive organisms, growth of S. aureus and M. luteus

was not inhibited at any concentration of hot water leaf extract.


Among gram negative organisms, growth of E. coli and

P. aeruginosa was not inhibited at any concentration of hot water leaf

extract.

ETHANOL



was not inhibited at any concentration of ethanol leaf extract.


Among gram negative organisms, growth of E. coli and

P. aeruginosa was not inhibited at any concentration of ethanol leaf

extract.

169

METHANOL



was not inhibited at any concentration of methanol leaf extract.




and at 2.5mg/ml it was 7.1mm. But P. aeruginosa did not show any

zone of inhibition at any concentrations of methanol leaf extract.

PETROLEUM ETHER



were not inhibited by hot water extract of Ziziphus oenoplia leaf.


Growth of E. coli was not inhibited at 0.5mg/ml and 1.0mg/ml

concentration, at 1.5mg/ml concentration the zone of inhibition was


But P. aeruginosa did not show any inhibition.

170

Table.IV.3.2.3a: Antibacterial activity of Ziziphus oenoplia leaf.




Hot Water

0.5 - - - -

1.0 - - - -

1.5 - - - -

2.0 - - - -

2.5 - - - -

Ethanol

0.5 - - - -

1.0 - - -

1.5 - - - -

2.0 - - - -

2.5 - - - -

Methanol

0.5 - - - -

1.0 - - - -

1.5 - - 6.0 ± 0.08 -

2.0 - - 6.5 ± 0.09 -

2.5 - - 7.1 ± 0.10 -

Petroleum

Ether

0.5 - - - -

1.0 - - - -

1.5 - - 8.0 ± 0.11 -

2.0 - - 8.1 ± 0.10 -

2.5 - - 8.5 ± 0.13 -

171

IV.4.3.2.3b. Antibacterial activity of Ziziphus oenoplia leaf by

Minimum Inhibitory Concentration [MIC]


Ziziphus oenoplia leaf extract against the bacteria by 2 fold serial

dilution assay [Figures are expressed in µg/ml].

Extracts S. aureus M. luteus E. coli P. aeruginosa

Hot water 500 625 550 475

Ethanol 475 500 400 575

Methanol 525 625 450 600










172

ANTIBIOTICS EFFECT

Effect of ampicillin on growth of different bacteria is represented in

table.IV.4.4. The antibiotic has no effect in growth of S. aureus.

Similarly in the 0.5mg/ml concentration of antibiotic cannot inhibit

the growth of E. coli and P. aeruginosa.

P. aeruginosa showed 5.2mm zone of inhibition at 1.0mg/ml

concentration, 5.6cm at 15%, and 5.9mm at 20% concentration and

6.2mm at 25% concentration. E. coli showed 5.3cm zone of inhibition

at 10% concentration, 5.7mm at 15% concentration, 6.0mm at 20%

concentration and 6.4mm at 25% concentration.

M. luteus showed 5.4mm zone of inhibition at 5% concentration,

5.7mm at 10% concentration, 5.9mm at 15% concentration, 6.2mm at

20% concentration and 6.6mm at 25% concentration.

Effect of Tetracycline on growth of different bacteria is represented

in table.IV.4.4. The antibiotic inhibited the growth of all experimented

organisms.

S. aureus showed 6.9mm zone of inhibition at 5% concentration,


20% concentration and 7.9mm at 25% concentration. M. luteus

showed 7.0mm zone of inhibition at 5mg/ml concentration, 7.4mm at

10mg/ml concentration, 7.7mm at 1.5mg/ml concentration, 7.9mm at

2.0% concentration and 8.2mm at 2.5mg/ml concentration.

173

E. coli showed 6.7mm zone of inhibition at 5% concentration, 6.9mm

at 10% concentration, 7.2mm at 15%, and 7.4mm at 20%

concentration and 7.7mm at 25% concentration. P. aeruginosa

showed 6.0mm zone of inhibition at 5% concentration, 6.1mm at 10%

concentration, 6.3mm at 15% concentration, 6.7mm at 20%


Effect of ciprofloxacin on growth of different bacteria is

represented in table.IV.4.4. The antibiotic inhibited the growth of all

experimented organisms.

S. aureus showed 6.9mm zone of inhibition at 5% concentration,


20% concentration and 7.9mm at 25% concentration. M. luteus




E. coli showed 6.7mm zone of inhibition at 5% concentration,


20% concentration and 7.7mm at 25% concentration. P. aeruginosa




174

Table.IV.4.4: Antimicrobial susceptibility to Ampicillin, tetracycline

and ciprofloxacin at various concentrations.


Antibiotics Concentration


Ampicillin

0.5 - 5.4 ± 0.05 - -

1.0 - 5.7 ± 0.07 5.3 ±0.04 5.2 ± 0.06

1.5 - 5.9 ± 0.08 5.7 ±0.05 5.6 ± 0.07

2.0 - 6.2 ± 0.07 6.0 ±0.07 5.9 ± 0.06

2.5 - 6.6 ± 0.06 6.4 ±0.05 6.2 ± 0.05

Tetracycline

0.5 6.9 ±0.04 7.0 ±0.06 6.7 ±0.04 6.0 ±0.06

1.0 7.1 ±0.06 7.4 ±0.05 6.9 ±0.05 6.1 ±0.05

1.5 7.4 ±0.07 7.7±0.05 7.2 ±0.06 6.3 ±0.05

2.0 7.7 ±0.07 7.9 ±0.07 7.4 ±0.07 6.7 ±0.06

2.5 7.9 ±0.06 8.2 ±0.08 7.7 ±0.07 6.9 ±0.06

Ciprofloxacin

0.5 6.9 ±0.05 7.0 ±0.06 6.7 ±0.06 6.0 ±0.07

1.0 7.1 ±0.06 7.4 ±0.07 6.9 ±0.05 6.1 ±0.07

1.5 7.4 ±0.07 7.7±0.06 7.2 ±0.04 6.3 ±0.05

2.0 7.7 ±0.05 7.9 ±0.06 7.4 ±0.04 6.7 ±0.05

2.5 7.9 ±0.05 8.2 ±0.05 7.7 ±0.05 6.9 ±0.06

IV. 1. PROFILE OF THERAPEUTIC DRUGS...

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