Global evidence on the potential of some Ugandan herbal medicines to mitigate antibiotic resistance: a meta-analysis across 21/2 decades

Introduction: Antibiotic-resistant bacteria (ARB), are continuing to heighten global mortality, and those causing diarrhoea and respiratory diseases are more common. In Uganda, plants like C. pyrrhopappa, E. abyssinica, C. limon, M. foetida, C. flexuosus, and C. citrinus are often used to treat diarrhoea and cough. Some of these plants are reported to demonstrate antibacterial properties in some countries, but the evidence is limited due to fragmented studies. We evaluated global antibacterial research on these plants, to derive practical insights, able to stimulate new thinking and inform drug development.Methods: Eligible articles from 14 electronic databases were examined using Standard Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Sensitive ARB to the plant extracts, and Cochran's Q test were evaluated using MedCalcs-software, publication bias using Begg's test and funnel plot asymmetry, and heterogeneity using sensitivity analysis, subgroup analysis, and meta-regression (P < 0.05).Results: Twenty studies assessed the plants against 237 ARB in vitro. C. flexuosus exhibited the highest efficacy (89.8%), which was not significantly different from the rest of the plants species except M. foetida and C. pyrrhopappa (0.0%) (?(2), P < 0.05). Multidrug-resistant strains with 100% sensitivity to plant extracts were A. baumannii, S. aureus, and P. aeruginosa.Discussion/Conclusions: Efficacy of these plants against globally circulating bacteria which are resistant to highly-powered, last-resort drugs like carbapenems, indicates potential global treatment success if they are used in drug development. In vivo efficacy studies, especially on the world's leading multidrug-resistant strains like K. pneumoniae and E. coli are warranted to bridge knowledge-gaps.