Susceptibility and Synergistic Effects of Guava Plant Extract and Antimicrobial Drugs on Escherichia coli

Introduction Psidium guajava (guava) is a fruit plant of the Myrtaceae family. Guava roots, leaves, and fruits have traditionally been used to prevent and treat various infections. In the last few decades, there has been exponential growth in herbal medicine. Therefore, the present study was conducted to determine the susceptibility and synergistic properties of the antimicrobial activity of the aqueous leaf extract of guava and other antimicrobial drugs against Escherichia coli (E. coli). Methodology A prospective observational study was conducted at the Department of Microbiology, MGM Medical College and Hospital, Navi Mumbai, India, involving 180 urine samples collected from patients who exhibited symptoms of urinary tract infection (UTI). The aim was to evaluate in vitro synergism between leaf extracts of guava and antimicrobial drugs on uropathogenic E. coli, using minimal inhibitory concentration (MIC) and the Kirby -Bauer method. The Kirby -Bauer disc diffusion method was employed to determine the synergistic activity using Muller -Hinton agar (MHA), and the zone of inhibition was measured in millimeters. Results The study found that, of the 180 urine samples collected from patients with UTI, significant growth was observed in 93 samples, with the most notable increase seen in E. coli. The antibiotics tobramycin, ofloxacin, and amikacin, each showing a sensitivity of 76% and 70% respectively, were found to be the most sensitive. Conversely, cefuroxime and cephalothin, both at 76%, were the most resistant. Furthermore, the antibiotic sensitivity pattern of E. coli without guava extract demonstrated tobramycin (TOB) at 76.66%, followed by ofloxacin (OF) and amikacin (AK) at 70% each, levofloxacin (LE) at 63.33%, nitrofurantoin (NIT) at 53.33%, trimethoprim (TR) at 43.33%, cefotaxime (CTX) at 36.66%, ceftizoxime (CZX) at 30%, norfloxacin (NR) at 26.66%, cephalothin (CEP) at 23.33%, amoxicillin-clavulanate (AMC) at 20%, and cefuroxime (CXM) at 10%. In contrast, when the antibiotic sensitivity pattern of E. coli with guava extract was examined, the highest sensitivity was noted for OF (100%), followed by LE (96.66%), TOB (93.33%), AK (90%), NIT (76.66%), AMC and TR (66.66% each), CTX (60%), CZX (53.33%), CEP (50%), NX (43.33%), and CXM (26.66%). Therefore, Psidium guajava (guava) extract exhibited a synergistic effect when combined with antibiotics, most notably with ofloxacin. Conclusion The study revealed that the highest synergistic activity of guava plant leaf extract was with the antibiotic ofloxacin. This finding indicates that guava extract enhances the effectiveness of commonly used antibiotics for treating UTI, an effect mainly attributed to the flavonoid compounds and their derivatives in the guava leaf extract, which inhibit bacterial growth. This study demonstrated the antibacterial properties of guava, suggesting that combining antibiotics with guava extract can help delay the emergence of bacterial resistance.