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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% anti- tubercular, 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
Private Public Pharmacist
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
Private Public Pharmacist
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
Private Public Pharmacist
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
Private Public Pharmacist
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
Private Public Pharmacist
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
Private Public Pharmacist
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
Private Public Pharmacist
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
Private Public Pharmacist
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
1 Ampicillin 42.9 0.0
2 Amoxicillin 0.0 17.6
3 Amoxicillin+Clavunate 0.0 23.5
4 Amikacin 0.0 11.8
5 Ciprofloxacin 0.0 5.9
6 Norfloxacin 7.1 0.0
Wound/Injury
1 Amikacin 0.0 21.1
2 Ampicillin 31.3 15.8
3 Ciprofloxacin 18.8 5.3
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
Gram positive organisms
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.
Gram negative organisms
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
S. No Antibiotics Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae Staphylococcus albus
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
S. No Antibiotics Escherichia coli Klebsiella pneumoniae Pseudomonas aeruginosa
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
Gram positive organisms
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
S. No Antibiotics Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae Staphylococcus albus
Resistance Sensitive Resistance Sensitive Resistance Sensitive Resistance Sensitive
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
S. No Antibiotics Escherichia coli Klebsiella pneumoniae Pseudomonas aeruginosa
Resistance Sensitive Resistance Sensitive Resistance Sensitive
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
Gram positive organisms
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%
resistant and 50.0% sensitive.
Gram negative organisms
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
Resistance Sensitive Resistance Sensitive Resistance Sensitive Resistance Sensitive
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
Resistance Sensitive Resistance Sensitive Resistance Sensitive
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
Gram positive organisms
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%.
Gram negative organisms
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
Resistance Sensitive Resistance Sensitive Resistance Sensitive Resistance Sensitive
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
S.No Antibiotics Escherichia coli Klebsiella pneumoniae Pseudomonas aeruginosa
Resistance Sensitive Resistance Sensitive Resistance Sensitive
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
Gram positive organisms
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
Resistance Sensitive Resistance Sensitive Resistance Sensitive Resistance Sensitive
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
S.No Antibiotics Escherichia coli Klebsiella pneumoniae Pseudomonas aeruginosa
Resistance Sensitive Resistance Sensitive Resistance Sensitive
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%
resistant and 50.0% sensitive.
Gram negative organisms
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
Gram positive organisms
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.
Gram negative organisms
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
Gram positive organisms
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
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.
Gram negative organisms
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
Gram positive organisms
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
concentrations, at 1.5mg/ml concentration the zone of inhibition was
5.0mm, at 2.0mg/ml it was 5.3mm and at 2.5mg/ml it was 5.5mm.
Gram negative organisms
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
inhibition was 5.3mm, at 2.0mg/ml it was 5.5mm and at 2.5mg/ml it
was 5.8mm.
PETROLEUM ETHER
Gram positive organisms
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, the zone of inhibition was
5.2mm, at 2.0mg/ml it was 5.5mm and at 2.5mg/ml it was 5.9mm.
Gram negative organisms
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,
E. coli and P. aeruginosa and has 250µg/ml, 300µg/ml and 75µg/ml
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
Five different concentrations [0.5, 1.0, 1.5, 2.0, and 2.5 (mg/ml)] of
various solvents were tested against: [table.IV.4.1.2.2a]
HOT WATER
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
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.
Gram negative organisms
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
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 5.6cm, at 2.0mg/ml it was
5.9mm and at 2.5mg/ml it was 6.1mm.
ETHANOL
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
inhibited by ethanol extract of Adhatoda vasica stem. While growth of
131
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 5.8mm and at 2.5mg/ml
it was 6.0mm.
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml and 1.0mg/ml
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
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
inhibited by hot water extract of Adhatoda vasica stem. While growth
of M. luteus was 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 5.2mm
and at 2.5mg/ml it was 5.6mm.
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml and 1.0mg/ml
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
5.5mm, at 2.0mg/ml it was 5.8mm and at 2.5mg/ml it was 6.0mm.
PETROLEUM ETHER
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
inhibited by hot water extract of Adhatoda vasica stem. While growth
of M. luteus was not inhibited at 0.5mg/ml and 1.0mg/ml
concentration, at 1.5mg/ml it was 5.0mm, at 2.0mg/ml it was 5.2mm
and at 2.5mg/ml it was 6.0mm.
133
Table.IV.4.1.2.2a: Antibacterial activity of Adhatoda vasica stem.
[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 - 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
minimum inhibitory concentration [MIC]
Table.IV.4.1.2.2b: Minimum Inhibitory Concentration [MIC] value of
Adhatoda vasica stem extract against the bacteria by 2-fold serial
dilution assay [Figures are in µg/ml].
Organisms S. aureus M. luteus E. coli P. aeruginosa
Hot water - 175 175 150
Ethanol - 175 200 150
Methanol - 175 200 200
Petroleum Ether - 200 - -
In hot water, S. aureus has no MIC value, where as M. luteus,
E. coli and P. aeruginosa and has 175µg/ml, 175µg/ml and 150µg/ml
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,
E. coli and P. aeruginosa and has 175µg/ml, 200µg/ml and 200µg/ml
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
Five different concentrations [0.5, 1.0, 1.5, 2.0, and 2.5 (mg/ml)] of
various solvents were tested against: [table.IV.4.1.2.3a]
HOT WATER
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
inhibited by hot water extract of Adhatoda vasica leaf. While growth of
M. luteus was not inhibited at 0.5mg/ml concentration but from
concentration 1.0mg/ml, the zone of inhibition was 5.3mm, at
1.5mg/ml it was 5.5mm, at 20mg/ml it was 5.7mm and at 2.5mg/ml
it was 6.0mm.
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml and 1.0mg/ml
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
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
inhibited by hot water extract of Adhatoda vasica leaf. While growth of
136
M. luteus was not inhibited at 0.5mg/ml concentration but from
concentration 1.0mg/ml, the zone of inhibition was 5.2cm, at
1.5mg/ml it was 5.4mm, at 2.0mg/ml it was 5.6mm and at 2.5mg/ml
it was 5.8mm.
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml concentration
and at 1.0mg/ml the zone of inhibition was 5.2mm, at 1.5mg/ml it
was 5.4mm, at 2.0mg/ml it was 5.8mm 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 5.3cm, at 1.5mg/ml it was 5.5mm, at 2.0mg/ml it was
5.9mm and at 2.5mg/ml it was 6.3mm.
METHANOL
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
inhibited by hot water extract of Adhatoda vasica leaf. 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 it was 5.3mm, at
2.0mg/ml it was 5.5mm and at 2.5mg/ml it was 5.8mm.
Gram negative organisms
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
5.5mm, at 1.5mg/ml it was 5.7mm, at 2.0mg/ml it was 5.9mm and at
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
inhibition was 5.6mm, at 2.0mg/ml it was 5.8mm and at 2.5mg/ml it
was 6.1mm.
PETROLEUM ETHER
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
inhibited by hot water extract of Adhatoda vasica leaf. 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 5.2mm, at
2.0mg/ml it was 5.4mm and at 2.5mg/ml it was 5.7mm.
Gram negative organisms
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 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.
[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 - 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
minimum inhibitory concentration [MIC]
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].
Organisms S. aureus M. luteus E. coli P. aeruginosa
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
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.4.2.2.1a]
Gram positive organisms
Gram Negative organisms
HOT WATER
Gram positive organisms
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
and at 2.5mg/ml it was 6.2mm.
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml concentration
and at 1.0mg/ml the zone of inhibition was 5.1mm, at 1.5mg/ml it
was 5.4mm, at 2.0mg/ml it was 5.8mm and at 2.5mg/ml it was
6.0mm. 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 inhibition was 5.1mm, at 2.0mg/ml it was
5.4mm and at 2.5mg/ml it was 5.8mm.
142
ETHANOL
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
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.
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml, 1.0mg/ml and
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
1.5mg/ml it was 5.3mm, at 2.0mg/ml it was 5.7mm and at 2.5mg/ml
it was 5.9mm.
METHANOL
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
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
1.5mg/ml it was 5.4mm, at 2.0mg/ml it was 5.8mm and at 2.5mg/ml
it was 6.0mm.
143
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml and 1.0mg/ml
concentration, at 1.5mg/ml it was 5.1mm, at 2.0mg/ml it was 5.5mm
and at 2.5mg/ml it was 5.9mm. Growth of P. aeruginosa was inhibited
at 0.5mg/ml concentration with a zone of inhibition of 5.2mm, at
1.0mg/ml the zone of inhibition was 5.5mm, at 1.5mg/ml it was
5.7mm, at 2.0mg/ml it was 6.1mm and at 2.5mg/ml it was 6.4mm.
PETROLEUM ETHER
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
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.
Gram negative organisms
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
1.5mg/ml it was 5.7mm, at 2.0mg/ml it was 6.0mm and at 2.5mg/ml
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
[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 - 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
minimum inhibitory concentration [MIC]
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].
Solvents S. aureus M. luteus E. coli P. aeruginosa
Hot water 275 200 100 300
Ethanol 375 300 375 200
Methanol - 200 300 75
Petroleum Ether - 100 75 100
In hot water S. aureus has 275µg/ml and M. luteus has 200µg/ml
where as E. coli has 100µg/ml and P. aeruginosa has and 300µg/ml.
In ethanol, S. aureus has 375µg/ml and M. luteus has 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
200µg/ml where as E. coli has 300µg/ml and P. aeruginosa has
75µg/ml.
In petroleum ether, S. aureus has no inhibition and M. luteus has
100µg/ml where as E. coli has 75µg/ml and P. aeruginosa has
100µg/ml.
146
IV.4.2.2.2a. Antibacterial activity of Aegle marmelosa stem 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.4.2.2.2a]
Gram positive organisms
Gram Negative organisms
HOT WATER
I. Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
inhibited by hot water extract of Aegle marmelos 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 5.1mm, at
1.5mg/ml it was 5.4mm, at 2.0mg/ml it was 5.7mm and at 2.5mg/ml
it was 5.9mm.
II. Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml concentration
and 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 6.0mm and at 2.5mg/ml it was
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
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
inhibited by hot water extract of Aegle marmelos 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 5.4mm, at
1.5mg/ml it was 5.7mm, at 2.0mg/ml it was 6.0mm and at 2.5mg/ml
it was 6.2mm.
Gram negative organisms
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
1.5mg/ml it was 5.9mm, at 2.0mg/ml it was 6.1mm and at 2.5mg/ml
it was 6.3mm.
METHANOL
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
inhibited by hot water extract of Aegle marmelos stem. While growth of
M. luteus was not inhibited at 0.5mg/ml and 1.0mg/ml concentration,
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
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml and 1.0mg/ml
concentration, at 1.5mg/ml it was 5.1mm, at 2.0mg/ml it was 5.5mm
and at 2.5mg/ml it was 5.9mm. Growth of P. aeruginosa was inhibited
at 0.5mg/ml concentration with zone of inhibition of 5.1mm, while 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 5.9mm and at 2.5mg/ml it was 6.1mm.
PETROLEUM ETHER
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
inhibited by hot water extract of Aegle marmelos 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 5.1mm, at
1.5mg/ml it was 5.3mm, at 2.0mg/ml it was 5.9mm and at 2.5mg/ml
it was 6.1mm.
Gram negative organisms
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.
[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 - 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
minimum inhibitory concentration [MIC]
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].
Organisms S. aureus M. luteus E. coli P. aeruginosa
Hot water - 200 150 175
Ethanol - 100 375 75
Methanol - 300 300 100
Petroleum Ether - 200 - -
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
100µg/ml where as E. coli and P. aeruginosa has 375µg/ml and
75µg/ml.
In methanol, S. aureus has no inhibition and M. luteus has
300µg/ml where as E. coli and P. aeruginosa has 300µg/ml and
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
Five different concentrations [0.5, 0.1, 1.5, 2.0, and 2.5 (mg/ml)] of
various solvents were tested against: [table.IV.4.2.2.3a]
Gram positive organisms
Gram Negative organisms
HOT WATER
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
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
2.0mg/ml it was 6.5mm and at 2.5mg/ml it was 7.2mm.
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml concentration
and at 1.0mg/ml the zone of inhibition was 5.2mm, at 1.5mg/ml it
was 6.1mm, at 2.0mg/ml it was 6.3mm and at 2.5mg/ml it was
7.0mm. 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 6.4m, at 2.0mg/ml it was
6.5mm and at 2.5mg/ml it was 6.8mm.
152
ETHANOL
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
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
2.0mg/ml it was 6.2mm and at 2.5mg/ml it was 6.9mm.
Gram negative organisms
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
1.5mg/ml it was 5.8mm, at 2.0mg/ml it was 6.0mm and at 2.5mg/ml
it was 7.2mm. Similarly, 0.5mg/ml and 1.0mg/ml concentration did
not effect the growth of P. aeruginosa, while at 1.5mg/ml the zone of
inhibition was 5.4mm, at 2.0mg/ml it was 5.7mm and at 2.5mg/ml it
was 6.1mm.
METHANOL
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
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
5.6mm, at 1.5mg/ml it was 6.2mm, at 2.0mg/ml it was 6.6mm and at
2.5µg/ml it was 7.0mm.
Gram negative organisms
Growth of E. coli was inhibited at 0.5mg/ml concentration with
5.2mm zone of inhibition and at 1.0mg/ml the zone of inhibition was
5.5mm, at 1.5mg/ml it was 5.8mm, at 2.0mg/ml it was 6.2mm and at
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
1.0mg/ml the zone of inhibition was 5.5mm, at 1.5mg/ml it was
6.1mm, at 2.0mg/ml it was 6.9mm and at 2.5mg/ml it was 7.2mm.
PETROLEUM ETHER
Gram positive organisms
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
2.0mg/ml it was 6.2mm and at 2.5mg/ml it was 6.2mm.
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml concentration
and at 1.0mg/ml the zone of inhibition was 5.2mm, at 1.5mg/ml it
154
was 5.8mm, at 2.0mg/ml it was 6.7mm and at 2.5mg/ml it was
6.7mm. 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 inhibition was 5.2mm, at 2.0mg/ml it was
6.0mm and at 2.5mg/ml it was 6.0mm.
155
Table.IV.2.2.3a: Antibacterial activity of Aegle marmelos leaf.
[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 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
Table.IV.2.2.3b: Minimum Inhibitory Concentration [MIC] value of
Aegle marmelosa leaf extract against the bacteria by 2 fold serial
dilution assay [Figures are in µg/ml].
Organisms S. aureus M. luteus E. coli P. aeruginosa
Hot water 150 225 175 150
Ethanol 125 75 100 225
Methanol 250 75 50 50
Petroleum Ether 250 175 150 275
In hot water S. aureus has 150µg/ml and M. luteus has 225µg/ml
where as E. coli and P. aeruginosa has 175µg/ml and 150µg/ml.
In ethanol, S. aureus has 125µg/ml and M. luteus has 75µg/ml
where as E. coli and P. aeruginosa has 100µg/ml and 225µg/ml.
In methanol, S. aureus has 250µg/ml and M. luteus has 75µg/ml
where as E. coli and P. aeruginosa has 50µg/ml and 50µg/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
disc diffusion method
Five different concentrations [0.05, 0.1, 1.5, 2.0, and 2.5 (mg/ml)] of
various solvents were tested against: [table.IV.4.3.2.1a]
Gram positive organisms
Gram Negative organisms
HOT WATER
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
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.
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml concentration
and at 1.0mg/ml the zone of inhibition was 6.2mm, at 1.5mg/ml it
was 6.4mm, at 2.0mg/ml it was 6.7mm and at 2.5mg/ml it was
7.3mm. 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 8.3mm, at 1.5mg/ml it was 8.5mm, at 2.0mg/ml it was
8.8mm and at 2.5mg/ml it was 9.1mm.
159
ETHANOL
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
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.
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml and 1.0mg/ml
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
Gram positive organisms
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
6.2mm, at 2.0mg/ml it was 6.3mm and at 2.5mg/ml it was 6.8mm.
160
Gram negative organisms
Growth of E. coli was inhibited at 0.5mg/ml concentration with
8.3mm zone of inhibition, at 1.0mg/ml the zone of inhibition was
8.5mm, at 1.5mg/ml it was 8.7mm, at 2.0mg/ml it was 8.9mm and at
2.5mg/ml it was 9.2mm. P. aeruginosa was not inhibited at any
concentrations of methanol extract.
PETROLEUM ETHER
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
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
1.0mg/ml, the zone of inhibition was 5.2mm, at 1.5mg/ml it was
5.4mm, at 2.0mg/ml it was 6.2mm and at 2.5mg/ml it was 6.2mm.
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml, 1.0mg/ml
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.
[Mean zone of inhibition was represented in mm with standard error]
Extract Concentration
[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
Table.IV.4.3.2.1b: Minimum Inhibitory Concentration [MIC] value of
Ziziphus oenoplia root extract against the bacteria by 2 fold serial
dilution assay [Figures are expressed µg/ml].
Solvents S. aureus M. luteus E. coli P. aeruginosa
Hot water 250 375 175 325
Ethanol 300 400 425 550
Methanol 250 450 400 500
Petroleum Ether 325 275 225 300
In hot water S. aureus has 250µg/ml and M. luteus has 375µg/ml
where as E. coli and P. aeruginosa has 175µg/ml and 325µg/ml.
In ethanol, S. aureus has 300µg/ml and M. luteus has 400µg/ml
where as E. coli and P. aeruginosa has 425µg/ml and 550µg/ml.
In methanol, S. aureus has 250µg/ml and M. luteus has 450µg/ml
where as E. coli and P. aeruginosa has 400µg/ml and 500µg/ml.
In petroleum ether, S. aureus has 325µg/ml and M. luteus has at
275µg/ml, E. coli 225µg/ml and P. aeruginosa has 300µg/ml.
163
IV.4.3.2.2a. Antibacterial activity of Ziziphus oenoplia stem 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.4.3.2.2a]
Gram positive organisms
Gram Negative organisms
HOT WATER
Gram positive organisms
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
1.5mg/ml it was 5.3mm, at 2.0mg/ml it was 5.7mm and at 2.5mg/ml
it was 5.9mm. While growth of M. luteus was not inhibited at
0.5mg/ml and 1.0mg/ml concentration but from concentration
1.5mg/ml, the zone of inhibition was 8.1mm, at 2.0mg/ml it was
8.4mm and at 2.5mg/ml it was 8.9mm.
Gram negative organisms
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 5.3mm
and at 2.5mg/ml it was 5.7mm. 0.5mg/ml and 1.0mg/ml
concentration did not effect the growth of P. aeruginosa, while at
1.5mg/ml the zone of inhibition was 7.5mm, at 2.0mg/ml it was
7.7mm and at 2.5mg/ml it was 8.3mm.
ETHANOL
Gram positive organisms
164
Among gram positive organisms, growth of S. aureus was not
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
and at 2.5mg/ml it was 10.5mm.
Gram negative organisms
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
8.4mm, at 2.0mg/ml it was 8.5mm and at 2.5mg/ml it was 8.8mm.
P. aeruginosa was not inhibited at any of the concentrations of ethanol
extract.
METHANOL
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
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
and at 2.5mg/ml it was 11.2mm.
165
Gram negative organisms
Growth of E. coli was not inhibited at 0.5mg/ml concentration and 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 10.6mm and at 2.5mg/ml it was
10.8mm. Growth of P. aeruginosa was not inhibited at any
concentrations of methanol extract.
PETROLEUM ETHER
Gram positive organisms
Among gram positive organisms, growth of S. aureus was not
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.
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml, 1.0mg/ml
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
2.0mg/ml it was 6.4mm and at 2.5mg/ml it was 6.7mm.
166
Table.IV.3.2.2a: Antibacterial activity of Ziziphus oenoplia stem.
[Mean zone of inhibition was represented in mm with standard error]
Extract Concentration
[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
minimum inhibitory concentration [MIC]
Table.IV.4.3.2.2b: Minimum Inhibitory Concentration [MIC] value of
Ziziphus oenoplia stem extract against the bacteria by 2 fold serial
dilution assay [Figures are expressed in µg/ml].
Solvents S. aureus M. luteus E. coli P. aeruginosa
Hot water 275 300 200 325
Ethanol 400 375 350 375
Methanol 325 400 375 275
Petroleum Ether 375 400 450 300
In hot water S. aureus has 275µg/ml and M. luteus has300µg/ml
where as E. coli and P. aeruginosa has 200µg/ml and 325µg/ml.
In ethanol, S. aureus has 400µg/ml and M. luteus has 375µg/ml
where as E. coli and P. aeruginosa has 350µg/ml and 375µg/ml.
In methanol, S. aureus has 325µg/ml and M. luteus has 400µg/ml
where as E. coli and P. aeruginosa has 375µg/ml and 275µg/ml.
In petroleum ether, S. aureus has 375µg/ml and M. luteus has at
400µg/ml, E. coli 450µg/ml and P. aeruginosa has 300µg/ml.
168
IV.4.3.2.3a. Antibacterial activity of Ziziphus oenoplia leaf 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.4.3.2.3a]
Gram positive organisms
Gram Negative organisms
HOT WATER
Gram positive organisms
Among gram positive organisms, growth of S. aureus and M. luteus
was not inhibited at any concentration of hot water leaf extract.
Gram negative organisms
Among gram negative organisms, growth of E. coli and
P. aeruginosa was not inhibited at any concentration of hot water leaf
extract.
ETHANOL
Gram positive organisms
Among gram positive organisms, growth of S. aureus and M. luteus
was not inhibited at any concentration of ethanol leaf extract.
Gram negative organisms
Among gram negative organisms, growth of E. coli and
P. aeruginosa was not inhibited at any concentration of ethanol leaf
extract.
169
METHANOL
Gram positive organisms
Among gram positive organisms, growth of S. aureus and M. luteus
was not inhibited at any concentration of methanol leaf extract.
Gram negative organisms
Growth of E. coli was also not inhibited at 0.5mg/ml and 1.0mg/ml
concentration, at 1.5mg/ml it was 6.0mm, at 2.0mg/ml it was 6.5mm
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
Gram positive organisms
Among gram positive organisms, growth of S. aureus and M. luteus
were not inhibited by hot water extract of Ziziphus oenoplia leaf.
Gram negative organisms
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
8.0mm, at 2.0mg/ml it was 8.1mm and at 2.5mg/ml it was 8.5mm.
But P. aeruginosa did not show any inhibition.
170
Table.IV.3.2.3a: Antibacterial activity of Ziziphus oenoplia leaf.
[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 - - - -
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]
Table.IV.4.2.3b: Minimum Inhibitory Concentration [MIC] value of
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
Petroleum Ether 450 525 350 475
In hot water S. aureus has 500µg/ml and M. luteus has 625µg/ml
where as E. coli and P. aeruginosa has 550µg/ml and 475µg/ml.
In ethanol, S. aureus has 475µg/ml and M. luteus has 500µg/ml
where as E. coli and P. aeruginosa has 400µg/ml and 575µg/ml.
In methanol, S. aureus has 525µg/ml and M. luteus has 625µg/ml
where as E. coli and P. aeruginosa has 450µg/ml and 600µg/ml.
In petroleum ether, S. aureus has 450µg/ml and M. luteus has at
525µg/ml, E. coli 350µg/ml and P. aeruginosa has 475µg/ml.
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,
7.1mm at 10% concentration, 7.4mm at 15% concentration, 7.7mm at
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%
concentration and 6.9mm at 25% concentration.
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,
7.1mm at 10% concentration, 7.4mm at 15% concentration, 7.7mm at
20% concentration and 7.9mm at 25% concentration. M. luteus
showed 7.0mm zone of inhibition at 5% concentration, 7.4mm at 10%
concentration, 7.7mm at 15% concentration, 7.9mm at 20%
concentration and 8.2mm at 25% concentration.
E. coli showed 6.7mm zone of inhibition at 5% concentration,
6.9mm at 10% concentration, 7.2mm at 15% concentration, 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%
concentration and 6.9mm at 25% concentration.
174
Table.IV.4.4: Antimicrobial susceptibility to Ampicillin, tetracycline
and ciprofloxacin at various concentrations.
[Mean zone of inhibition was represented in mm with standard error]
Antibiotics Concentration
(mg/ml) S. aureus M. luteus E. coli P. aeruginosa
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