1. Introduction
Antimicrobial resistance (AMR) is one of the most concerning public health issues of the 21st century. The development of AMR mechanisms in bacterial pathogens leads to lower efficacies for standard antimicrobial therapies, which in turn promotes the transmission of these infections. The World Health Organisation (WHO) has highlighted antimicrobial resistance (AMR) as a major danger to global health, food security, and future development, with far-reaching effects on human health and economic stability [
1]. Antibiotic resistant bacterial strains have rapidly arisen due to antibiotic misuse and overuse in humans and animals, as well as in agriculture. Antibiotic misuse includes excessive antibiotic prescriptions, poor treatment compliance, and the widespread use of antibiotics in livestock for growth promotion and disease prevention. This results in longer illness durations, higher mortality rates, and elevated healthcare costs [
1]. AMR mortality and morbidity are concerning. AMR caused 1.27 million deaths worldwide in 2019, and current trends indicate that this number will climb dramatically [
1]. Infections caused by antibiotic-resistant bacteria, such as methicillin-resistant
Staphylococcus aureus (MRSA) and multidrug-resistant
Escherichia coli, are particularly concerning due to their high resistance rates and severe clinical outcomes [
2]. The costs associated with AMR are multifaceted, encompassing direct medical costs such as longer hospital stays and more intensive care, as well as indirect costs such as lost productivity and long-term disability. According to the World Bank, by 2050 AMR is likely to cause a loss of global economic output amounting to USD 1 trillion annually, with healthcare costs also projected to increase significantly [
3].
The 2022 Global Antimicrobial Resistance and Use Surveillance System (GLASS) report underscores the significant concern regarding the alarming resistance rates of third-generation cephalosporin-resistant
E. coli and MRSA in 76 countries [
1,
4]. That report also found a significant rise in
E. coli infections resistant to ampicillin, co-trimoxazole, and fluoroquinolones. The common intestinal bacterium
Klebsiella pneumoniae has also shown increased resistance to penicillins, cephalosporins and fluoroquinolones. These elevated levels of antibiotic resistance may lead to an increase in the use of last-resort medications, such as carbapenems [
1,
4]. The rise of antibiotic-resistant bacteria has outpaced drug development. The high expenditures and limited financial returns of antibiotic research and development have caused a sharp fall in the number of novel antibiotics approved for clinical use [
5]. According to the WHO, there is a concerning lack of new antibacterials in the pipeline due to the lengthy research and development processes, and the high probability of failure during clinical testing [
6]. Thirteen new antibiotics have received therapeutic authorisation since July 2017. However, only two of these antibiotics constitute a new chemical class and are considered innovative [
6]. This highlights the significant scientific and technical difficulties in finding new antibacterials that are both effective against bacteria and safe for human use.
Exploring the potential of medicinal plants in the development of antimicrobial drugs presents numerous benefits compared to conventional antibiotics. Traditional medicinal plants offer an accessible and cost-effective alternative, requiring fewer resources and less time for production [
7]. They often interact with the body in a safe manner, causing minimal side effects, and often have complementary effects that enhance overall well-being. However, medicinal plants can also cause toxicity if misused. Therefore, careful dosing, accurate identification, and monitoring are essential to avoid adverse effects. Phytochemicals in medicinal plants may work together to boost antibacterial efficacy, potentiating the treatment’s efficacy [
7,
8]. Medicinal plants possess a variety of mechanisms of action, which holds great promise in combating antibiotic-resistant bacteria [
8]. The combination of plant extracts/compounds with conventional antibiotics is a strategy that can be utilised in the development of new antimicrobial therapies [
9]. Phytochemicals may enhance antibiotic efficacies through synergistic and additive interactions, potentially overcoming resistance issues. This approach offers a promising solution for developing effective treatments against antibiotic-resistant bacterial strains. For example, propolis ethanolic extract potentiates the efficacy of ampicillin and vancomycin against the methicillin resistant
S. aureus (MRSA) [
10].
The current study focuses on the antibacterial activity, phytochemistry, and toxicity of fruit extracts (aqueous, methanol, and ethyl acetate) derived from
Terminalia bellirica (Gaertn.) Roxb. and
Terminalia chebula Retz. Antibiotic sensitive and resistant bacterial pairs of
S. aureus,
E. coli, and
K. pneumoniae were examined for their growth in the presence of the extracts, as well as a panel of reference antibiotics. Our previous work revealed enhancements of
E. coli antibacterial activity when
T. bellirica and
T. chebula fruit extracts were combined [
11]. However, antibiotic-resistant bacterial species were not tested in that study, nor were combinational interactions between pure antibiotics and the plant extracts examined. Thakur et al. (2024) recently identified good antibacterial activities of the
T. bellirica aqueous fruit extract against
S. aureus, E. coli, and
E. coli 385 (an antibiotic-resistant strain), with minimum inhibitory concentrations (MICs) of 312 µg/mL, 1250 µg/mL and 625 µg/mL against these species, respectively [
12]. Phytochemical analysis was conducted by liquid chromatography–mass spectrometry (LC-MS), which identified a single polyphenol compound, bergenin [
12]. Interestingly, flavonoids, tannins and terpenoids were not identified in the
T. bellirica fruit extracts in that study. Furthermore, combinational interactions between reference antibiotics and the extracts were not explored. In addition, prior studies have demonstrated that fruit extracts of
T. bellirica exhibit antibacterial activity against
S. aureus,
E. coli, and
K. pneumoniae [
13,
14,
15]. However, those investigations did not include combinational studies of extracts with antibiotics and testing of antibiotic-resistant bacterial strains. Other investigations reported inconsistent results for
T. chebula fruit extracts (aqueous, ethanol, and dimethylformamide) against
S. aureus and
K. pneumoniae, with ZOIs of 15-18 mm on agar, using 500 µg extract per disc [
16]. Furthermore, low to inactive antibacterial activities of
T. chebula fruit extracts were observed against antibiotic sensitive and resistant strains of
S. aureus and
E. coli [
17,
18].
In order to address the discrepancies in the previous studies regarding the activities of T. bellirica and T. chebula, and the absence of thorough phytochemical analyses of the extracts, we investigated the antibacterial properties of aqueous, methanolic, and ethyl acetate fruit extracts obtained from T. bellirica and T. chebula. Our study focused on selected bacterial pathogens, but included resistant strains of S. aureus, E. coli, and K. pneumoniae. We conducted disc diffusion and liquid microdilution assays to assess their effectiveness. Additionally, LC-MS was utilised to examine the phytochemical composition of T. bellirica and T. chebula and to identify specific flavonoid, phenolic acid, terpenoid, and tannin molecules. In addition, our study investigated the interactions between active plant extracts and a panel of reference antibiotics when tested as extract-antibiotic combinations in MIC assays. Finally, the toxicities of the extracts were assessed using Artemia franciscana Kellogg nauplii lethality assays to provide initial insights into the safety of the extracts for possible clinical use.
3. Discussion
Our study tested
T. bellirica and
T. chebula fruit extracts against a group of bacterial pathogens that are significant for human health, including strains that are resistant to antibiotics. Significantly, the aqueous and methanolic extracts effectively suppressed the growth of the six bacterial pathogens examined in this study, underscoring their potential as targets for plant-based antibiotics development. The methanolic extracts exhibited the highest antibacterial efficacy in both the disc diffusion and liquid microdilution experiments against all pathogens. The ethyl acetate
T. bellirica and
T. chebula extracts also exhibited good antibacterial activities against
S. aureus and MRSA in the disc diffusion and broth microdilution assays. In addition, the
T. chebula ethyl acetate extract showed moderate antibacterial efficacy against
K. pneumoniae. The differences in net yields and the populations of phytochemicals extracted by different solvents may account for these variances in potency. Methanol and water have a higher polarity compared to ethyl acetate, which results in the extraction of a larger quantity of phytochemicals with high to mid-polarity. In contrast, ethyl acetate extracts a smaller number of compounds with mid to lower polarity [
20]. The differences in phytochemical contents among the extracts may potentially contribute to the varied antibacterial growth inhibition effects observed in the disc diffusion and liquid dilution investigations. Phytochemicals that have lower polar or are larger in size diffuse less rapidly through solid agar, resulting in a decrease in their apparent antibacterial effectiveness in disc diffusion assays [
21]. The solubility of these phytochemicals in broth is also influenced by their polarity [
22], which in turn impacts their ability to dissolve and may lead to inaccurate MIC values. Prior research has demonstrated that the depth of agar in petri dishes, as well as the regularity of the agar, may impact the extent of zones of inhibition (ZOIs) in agar diffusion studies [
23]. Whilst we followed manufacturers’ instructions to create agar of uniform consistency and poured it at a consistent depth of 4 mm, repeating the disc diffusion experiments at varying agar depths may be useful to confirm the ZOIs of all the extracts and antibiotics. In this investigation, we noticed that the borders of the zone of inhibition (ZOI) were clearly visible for
S. aureus and MRSA, although they were less clear (regarded as no ZOI) for the other bacterial pathogens studied. It is important to note that in future research, the use of methylene blue or crystal violet to stain the plates may enhance the visibility of ZOIs if there is low clarity [
24].
Notably, the MRSA strain tested herein showed resistance to many commonly used antibiotics, such as β-lactams (penicillin G, oxacillin, amoxicillin), and macrolides (erythromycin). Nevertheless, the emergence of extend spectrum β-lactamase enzymes has made these medications less effective against some bacterial strains. Likewise, macrolide antibiotics such as erythromycin are commonly employed because they have the ability to impede protein synthesis in bacteria [
25]. The existence of MRSA resistance to macrolides complicates the availability of treatment options, highlighting the need for new therapeutic drugs and procedures. Hence, it is imperative to identify innovative compounds that can elude or surmount these resistance mechanisms. The antibacterial activities observed with
T. bellirica and
T. chebula extracts against
S. aureus and MRSA produced similar MIC values ranging from 94 µg/mL to 900 µg/mL. These findings indicate that the resistance mechanisms observed in the MRSA strain have little influence on the active compounds of the extracts. Thus, the extract compounds either function through different mechanisms, or they may inhibit the bacterial antibiotic-resistance pathways.
The
mecA gene plays a crucial role in the resistance of MRSA [
26]. This gene codes for a new penicillin-binding protein (PBP2a) that has a reduced ability to bind to β-lactam antibiotics. This protein provides the bacteria with resistance against many β-lactam antibiotics by enabling them to produce cell walls, even in the presence of these medications. Hence, the mechanisms by which the phytochemicals in the extract function may vary from those of β-lactam antibiotics, even in bacteria that are resistant to β-lactam antibiotics. Alternatively, these extracts may contain phytochemicals that disrupt the bacterial strains’ defence mechanisms against these medicines, thereby allowing them to function at higher potency [
26]. This outcome is promising because, when compared to the susceptible strain, the MRSA strain in our study exhibited significantly diminished susceptibilities/ increased resistance to a range of antibiotics from the β-lactams, macrolides and fluoroquinolones classes.
Aqueous and methanol
T. bellirica and
T. chebula extracts exhibited antibacterial activity against
E. coli and its antibiotic resistant counterpart, ESBL
E. coli. The methanolic
T. bellirica extract showed noteworthy antibacterial activity against both bacterial pathogens, with identical MIC values. Similarly, the methanolic
T. bellirica and
T. chebula extracts also inhibited the growth of
K. pneumoniae and ESBL
K. pneumoniae, with similar MIC values. These results suggest that the methanolic extracts of both plants may contain compounds that have a broad efficacy against strains of
E. coli and
K. pneumoniae, including those that produce ESBL enzymes. Their efficacy might be linked to a distinct mechanism of action that contrasts those of β-lactam antibiotics. For example, the plant extracts may affect how bacteria form their cell walls, how well their membrane’s function, or they may affect other essential processes independent of the β-lactam antibiotic mechanism [
27]. In addition, it is possible that the methanolic extracts of both plants are exerting antibacterial effects through mechanisms that do not directly interfere with or inhibit the ESBL enzymes. Additional research is necessary to ascertain whether the plant extracts specifically hinder the resistance mechanisms of ESBL bacterial pathogens, or if they function via independent antibiotic pathways. This may require assessment of the effects of the extract/isolated components on β-lactamase inhibition, or by investigating the impact of the extract on the production of resistance genes in ESBL strains.
We also examined the use of
T. bellirica and
T. chebula extracts in combinations with conventional antibiotics. This method holds great promise for developing novel antibiotic chemotherapies, as many bacteria have developed resistance to conventional antibiotics, and plant compounds may provide ways of inhibiting/blocking these resistance mechanisms [
4]. Our goal was to enhance the efficacy of antibiotics and possibly negate the bacterial resistance mechanisms by mixing them with extracts from plants. Augmentin
®, a combination of amoxicillin and clavulanic acid, is a well-known example of how combining medications can improve treatment outcomes [
28] since clavulanic acid inhibits β-lactamase enzymes present in resistant bacteria. This enables amoxicillin to specifically target and eliminate the bacteria with greater efficiency, even in β-lactam resistant bacterial strains. Clavulanic acid acts as a β-lactamase inhibitor by binding permanently to the active site of the enzyme, therefore inhibiting the breakdown of the antibiotic.
Our investigation found that penicillin G, amoxicillin, in combination with the plant extracts, have additive effects against
S. aureus, which may be due to the presence of phytochemicals that possess anti-β-lactamase activities [
29]. These phytochemicals can hinder the activity of β-lactamase enzymes, thereby contributing to antibiotic resistance by breaking down the β-lactam ring found in β-lactam antibiotics, such as penicillin and amoxicillin [
30]. In addition, phytochemicals found in the plant extracts may interact with β-lactamase enzymes in a way that is comparable to clavulanic acid, although this requires confirmation. Regardless of the mechanism, this interaction helps protect the antibiotics from being broken down by bacterial enzymes and improves their ability to fight against bacterial pathogens. Plant extracts may possess the capacity to function as an alternative treatment method and could be a safe and less detrimental option for addressing antibiotic resistance [
9]. In comparison to synthetic antibiotics, natural compounds found in plants frequently exhibit fewer adverse effects and a lower likelihood of generating resistance [
8]. Moreover, the likelihood of further antibiotic-resistance development may be reduced by the variety of phytochemicals present in plant extracts, which may act on multiple bacterial pathways.
The ethyl acetate
T. chebula extract exhibited additive effects against
S. aureus in combination with erythromycin. It is possible that the extract and erythromycin may target distinct bacterial processes. Erythromycin inhibits protein synthesis by binding to the 50S ribosomal subunit [
31], whereas the plant extract may impact other bacterial targets, including cell wall synthesis, membrane integrity, or metabolic processes [
30]. Further studies are required to determine which of these mechanisms are affected by the extracts. Notably, this complementary targeting has the potential to improve the overall antibacterial effect. Furthermore, the plant extract may also influence other mechanisms associated with bacterial resistance, such as the disruption of efflux pumps or the modification of cell wall structures [
30], which could render bacteria more susceptible to erythromycin. The extract may also disrupt bacterial protective barriers, which could facilitate the improved penetration of erythromycin into the cell. Additionally, the plant extract may contain a variety of bioactive compounds [
8] that work in conjunction to enhance the efficacy of erythromycin. Alternatively, the extract may exhibit broad-spectrum antimicrobial activity that complements the specific effects of erythromycin. Similarly, the methanolic and ethyl acetate extracts of
T. chebula exhibited additional antibacterial effects against
K. pneumoniae when combined with chloramphenicol. This antibiotic binds to the 23S rRNA component of the 50S ribosomal subunit of the bacterial ribosome [
32]. This binding suppresses the peptidyl transferase activity, a crucial process for the creation of peptide bonds during protein synthesis. Chloramphenicol inhibits bacterial protein production by blocking the formation of peptide bonds.
Our research determined that when tetracycline is combined with
T. chebula extracts, the combination exhibited additive interactions against
S. aureus, MRSA,
E. coli and
K. pneumoniae, suggesting enhanced antibacterial efficacy. However, the aqueous
T. bellirica extract only showed an additive interaction against MRSA. Tetracycline resistance is mostly commonly attributed to tetracycline-specific efflux pumps [
33]. Hence, the observed additive effect indicates that the
T. bellirica and
T. chebula extracts might have hindered the functioning of these efflux pumps. By inhibiting efflux pumps, tetracycline is allowed to remain inside cells for a longer period, which increases its effectiveness. Whilst ribosomal changes may also contribute to tetracycline resistance, this pathway is substantially less common [
33]. Our research findings suggest that a broad range of phytochemicals found in the extracts of
T. bellirica and
T. chebula may have antibacterial action against several different bacteria. Similarly, plant extracts prepared from
Phyllanthus niruri L.,
Berberis vulgaris L., and
Piper nigrum L. exhibit additive interactions in combination with tetracycline, and can inhibit tetracycline efflux pumps [
34,
35].
Interestingly, the
T. bellirica and
T. chebula ethyl acetate extracts exhibited additive interactions in combination with ciprofloxacin against MRSA. This indicates that ethyl acetate extracts contain phytochemicals that may target different bacterial processes such as cell membrane disruption, inhibition of cell wall synthesis, or interference with metabolic pathways [
30]. The plant extract’s unique mechanisms may enhance the effectiveness of ciprofloxacin’s DNA-targeting action, resulting in a more comprehensive treatment [
8]. The plant extract may also enhance the cellular absorption of ciprofloxacin (thereby increasing its intracellular concentration) or may block/inhibit MRSA’s antibiotic-resistance mechanisms [
35].
Notably, polymyxin B and
T. bellirica, and
T. chebula extracts combinations exhibited substantial antagonistic interactions. The antagonistic interaction between polymyxin B and the plant extracts may be affected by variations in pH levels in the broth. Polymyxin B, which breaks bacterial cell membranes by binding to lipopolysaccharides, is pH sensitive, with substantially reduced potency under acidic or alkaline circumstances [
36]. The inclusion of plant extracts may cause a change in the pH of the broth, which could affect the efficacy of both polymyxin B and the plant chemicals, potentially resulting in a decrease in overall antibacterial activity, although this remains to be confirmed in future studies. Changes in pH may also impact bacterial physiology, thereby reducing the vulnerability of bacteria to the combined actions of the two substances. Polymyxin B and the components of plant extracts may also have chemical interactions that are regulated by pH [
36], which may further contribute to the antagonistic effects of the combination. Moreover, the antagonistic interactions between the extracts and polymyxin B can be ascribed to the binding of bioactive phytochemicals with polymyxin B, which impedes its absorption and efficacy in targeting bacterial cells [
37]. Hence, understanding these dynamics is critical for optimising combination medicines and assuring antimicrobial efficacy. Future studies are planned to examine these effects.
LC-MS metabolomics analysis of the
T. bellirica and
T. chebula fruit extracts highlighted the presence of flavonoids, tannins, terpenoids and phenolic acid compounds (
Table 3). Complete, comprehensive lists of phytochemicals present in the individual plant extracts are available as the supplementary files (
Supplementary Materials: Tables S1 and S2). Notable phytochemicals identified in both plant extracts include quinic acid (
Figure 2A), shikimic acid (
Figure 2B), aureusidin 6-glucuronide (
Figure 2C), madecassic acid (
Figure 2D), pedunculoside (
Figure 2E), 6-galloylglucose (
Figure 2F), 1,2,6-trigalloyl-β-D-glucopyranose (
Figure 2G), propyl gallate (
Figure 2H), methyl gallate (
Figure 2I), theogallin (
Figure 2J), gallic acid (
Figure 2K), ellagic acid (
Figure 2L), sanguiin H4 (
Figure 2M), hamamelitannin (
Figure 2N), pyrogallol (
Figure 2O), chebulic acid (
Figure 2P), chebuloside II (
Figure 2Q), and 1,6-bis-O-(3,4,5-trihydroxybenzoyl) hexopyranose (
Figure 2R). The scientific literature has documented the presence of gallic acid, ellagic acid, chebulic acid, chebuloside II, methyl gallate, propyl gallate, ethyl gallate, phloroglucinol, pyrogallol, quercetin, kaempferol, and various others compound in the fruit extracts of
T. bellirica and
T. chebula [
38,
39,
40]. In our previous study, we conducted qualitative GC-MS headspace analysis on aqueous, methanol and ethyl acetate fruit extracts of
T. bellirica and
T. chebula. Our analysis revealed the presence of several notable volatile terpenoids, including eucalyptol, linalool, methoxycitronellal, terpinene-4-ol, camphor, pinocarveol, carvone, endo borneol, L-fenchone, hyscylene, patchoulane, p-cumic aldehyde, and phenylbutanal [
11].
Notably, Embaby et al. (2019) showed synergistic antibacterial activity of quinic acid-rich acetone bark extract of
Ficus macrocarpa var. nitida. with tetracycline against
E. coli and
S. aureus [
41]. Furthermore, an
in-silico molecular docking study revealed that 5-caffeol quinic acid (and other phenolic compounds) may have antibacterial activity due to their efflux pump inhibitory effect. However, the study did not investigate the interactions between the plant extracts and conventional antibiotics. Another study reported that the antibacterial activity of quinic acid against
E. coli and
S. aureus, with MIC of 500 µg/mL to 1000 µg/mL, respectively [
42]. Additionally, Zhang et al. (2024) reported synergistic antibacterial effects for shikimic acid (625 µg/mL) in combination with penicillin, ampicillin, amoxicillin, and ceftiofur against MRSA, with and significantly reduced MIC values reported for the combinations (4 to 16-fold decreases) [
43]. Similarly, other investigations have shown that phloroglucinol derivatives exhibited synergistic antibacterial activity against MRSA in combination with vancomycin, penicillin and doxycycline [
44,
45,
46], despite phloroglucinol itself lacking antibacterial activity against MRSA, yielding a high MIC of over 10,000 µg/mL [
45].
We identified the flavonoid glucuronide, aureusidin 6-glucuronide in the ethyl acetate extracts of
T. bellirica and
T. chebula. Notably, studies evaluating the antibacterial activity of this compound are lacking in the literature, as are studies evaluating its effects in combination with conventional antibiotics. In addition, madecassic acid, a pentacyclic triterpenoid has been identified in the
T. chebula ethyl acetate extracts in our study. Previous studies have reported noteworthy antibacterial activity of madecassic acid against
S. aureus, MRSA, and
E. coli, with MIC values of 31.25 (61.9 μM), 62.5 (124 μM), 250 µg/mL (495 μM), respectively [
47]. These findings indicate that the madecassic acid exhibits more efficacy against Gram-positive bacteria, including
S. aureus and MRSA, compared to Gram-negative bacteria such as
E. coli. This discrepancy in effectiveness may be attributed to variations in cell wall structures and methods of action. These values aid in determining the most effective dosage levels and emphasise the potential of madecassic acid as a specific treatment for antibiotic-resistant bacteria, such as MRSA. Moreover, these findings establish a basis for future investigations, such as doing combination studies with different antibiotics to improve effectiveness. Antibacterial mechanism-focused experiments showed that madecassic acid destroys cell wall integrity, inhibiting the synthesis of soluble proteins and DNA topoisomerase I and II [
47]. Pedunculoside, a triterpene saponin has been identified in the methanol and ethyl acetate
T. chebula extracts. Interestingly, an older study reported the antibacterial effects of pedunculoside against
S. aureus and
E. coli, with MIC values of 200 µg/mL [
48]. However, there is a shortage of literature on the combined effects of pedunculoside and antibiotics.
Previous work has documented the antibacterial activity of penta-galloyl-glucose against
S. aureus and
E. coli, with a MIC of 250 µg/mL (266 µM) against both bacteria [
49]. The postulated mechanism of antibacterial activity is related to the suppression of the bacterial type II fatty acid production pathway. Another study reported broad-spectrum antibacterial activity of penta-galloyl-glucose against both methicillin-resistant
S. aureus and quinolone-resistant
S. aureus and
E. coli, with MIC values ranging from 64–128 µg/mL (68 µM and 136 µM, respectively) [
50]. The antibacterial activities of four derivatives of galloyl-β-D-glucose have also been investigated against multidrug-resistant
E. coli and
K. pneumoniae strains, with MIC values from 32 µg/mL to 128 µg/mL respectively (26-136 µM), [
51]. However, combinational interactions of galloyl-β-D-glucose derivatives with reference antibiotics have not been conducted to date.
Our LC/MS experiments also identified the galloyl-glucose derivatives 1,2,6-trigalloyl-β-D-glucopyranose, 1,6-bis-O-(3,4,5-trihydroxybenzoyl) hexopyranose, and 6-O-[(2E)-3-phenyl-2-propenoyl]-1-O-(3,4,5-trihydroxybenzoyl)-β-D-glucopyranose in both
T. bellirica and
T. chebula extracts. Previous studies have reported that relatively high levels of gallotannins are present in
T. bellirica and
T. chebula extracts [
40,
52,
53,
54]. Notably, efflux pump inhibitory activity has previously been demonstrated for 1,2,6-tri-
O-galloyl-β-D-glucopyranose against multidrug-resistant (MDR) uropathogenic
E. coli [
55]. Additionally, 1,2,6-tri-
O-galloyl-β-D-glucopyranose exhibits synergistic antibacterial activity in combination with gentamicin and trimethoprim against
E. coli [
56]. Synthetic gallotannins also exhibit antibiofilm and antimicrobial activity against
S. aureus and MRSA strains [
57].
Synergistic interactions between orbifloxacin and propyl gallate against the
E. coli resistant strain KVCC 1423 have previously been reported, with MIC values of the combination being reduced from 125 µg/mL (316 µM, orbifloxacin only) to 7.8 µg/mL (19.7 µM), and 312.5 µg/mL (1472 µM, propyl gallate only) to 78 µg/mL (367 µM), respectively [
58]. In the present study, LC-MS analysis, propyl gallate was identified only in the
T. chebula extracts, although methyl gallate was identified in both
Terminalia species. Tamang et al. (2022) investigated the antibacterial activities of erythromycin, ampicillin, gentamicin, kanamycin, and ciprofloxacin in combination with gallic acid, methyl gallate, ethyl gallate, propyl gallate, butyl gallate, octyl gallate, dodecyl gallate, and stearyl gallate against MRSA [
59]. It was noted in that study that octyl gallate (4 µg/mL) exhibited significant antimicrobial synergy against MRSA in combination with penicillin, ampicillin, cephalothin, gentamicin, tetracycline, erythromycin and lincomycin, reducing their MIC values from 64 µg/mL to 0.25–16 µg/mL.
A recent study reviewed the antimicrobial characteristics of sanguiins, highlighting their capacity to inhibit bacterial growth and the production of biofilms [
60]. The antibacterial activity of sanguiin H6, a closely related compound to sanguiin H4, was demonstrated against
S. aureus and MRSA, with a MIC value of 250 µg/mL [
60,
61]. Sanguiin H4 has been identified in the polyphenolic extract of
Sanguisorba officinalis L., which exhibited antibacterial activity
S. aureus and
E. coli [
62]. However, data is not available for the combinatorial interactions of sanguiins with antibiotics to combat AMR. The combination of gallic acid and thiamphenicol, and the combination of hamamelitannin with thiamphenicol or erythromycin, exhibited synergistic antibacterial effects against
E. coli. (ATCC 25922) [
63]. Furthermore, study detected additional antibacterial interactions against
E. coli when combining gallic acid with ampicillin, or cefotaxime, and/or marbofloxacin, as well as when combining hamamelitannin with amoxicillin or marbofloxacin. Interestingly, gallic acid and hamamelitannin each have moderate antibacterial activity against
E. coli, with MIC values of 1024 µg/mL (6024 µM) and 2048 µg/mL (4230 µM), respectively [
63]. Bassyouni et al. (2015) noted that hamamelitannin (20 µg/mL) reduces the MIC of vancomycin (4 µg/mL), and clindamycin (32 µg/mL) to 0.25 µg/mL against MRSA strains [
64]. Furthermore, hamamelitannin in combination with vancomycin and clindamycin effectively inhibit the biofilm formation in MRSA strains.
Our present study identified chebulic acid, a gallotannin compound in the aqueous extract of
T. bellirica and all extracts of
T. chebula. Chebulic acid has demonstrated numerous biological activities including anti-tumor activity, anti-atherogenic, anti-fibrotic, anti-ulcer, and antioxidant effects [
65]. Yang et al. (2020) identified and isolated twenty chebulic acid and brevifolincarboxylic acid derivatives from an ethanolic extract prepared from the arial parts of
Euphorbia hirta L. [
66]. All of those compounds exhibited significant free radical scavenging activities, although antibacterial activity was not investigated in that study. Both ethyl gallate and tri-n-butyl chebulate have been isolated from the aqueous
T. chebula fruit extract [
67]. Both compounds inhibit
K. pneumoniae growth, with MIC values of 156 µg/mL (787 µM) and 1250 µg/mL, respectively. However, combinational interactions with antibiotics were not investigated in that study. In the present study, chebuloside II was only identified in the methanolic
T. chebula fruit extract. In contrast, several earlier studies reported the presence of chebuloside II in both
T. bellirica and
T. chebula extracts [
40,
53,
54,
68]. Chebuloside II rich
T. chebula extracts exhibit hepatoprotective effects and prevent liver toxicity in animal models [
68], although there is a lack of studies examining the antibacterial activity and combinational interactions of chebuloside II with conventional antibiotics.
In the present study, the extracts were found to be rich in gallic acid, ellagic acid and pyrogallol. Previous studies showed that gallic acid acts synergistically in combination with norfloxacin against
S. aureus [
69]. This combination decreases the MIC of norfloxacin from 156 μg/mL to 49 μg/mL. In addition, gallic acid lowered the MIC of gentamicin against
S. aureus from 49 μg/mL to 2.5 μg/mL. Similarly, ellagic acid lowered the MIC of tetracycline, chloramphenicol, and tobramycin against a multidrug resistant isolate of
E. coli [
70]. Quave et al. (2012) showed that ellagic acid and its derivatives isolated from the roots of
Rubus ulmifolius Schott. inhibited
S. aureus growth by inhibiting biofilm formation [
71]. Pyrogallol exhibited antibacterial activity against
S. aureus and reduced the MIC of norfloxacin from 156 μg/mL to 78 μg/mL, and gentamicin from 49 μg/mL to 2.5 μg/mL [
69]. In addition, pyrogallol exhibited broad-spectrum antibacterial activities against methicillin-susceptible
S. aureus, MRSA,
E. coli (ATCC 25922), colistin-resistant
E. coli, and colistin-resistant
K. pneumoniae [
72].
We were unable to detect synergistic enhancement of antibacterial activity between T. bellirica and T. chebula extracts and any of the antibiotics we selected against the bacterial pathogens investigated. However, additive interactions of extracts were noted in some combinations containing penicillin G, amoxicillin, erythromycin, chloramphenicol, tetracycline and ciprofloxacin against S. aureus, MRSA, E. coli, and ESBL K. pneumoniae. This indicates that the phytochemicals present in the T. bellirica and T. chebula extracts may possess β-lactamase and/or efflux pump inhibitory properties. Further research is required to investigate the effects of these extracts against those resistance mechanisms.
The toxicity assays using Artemia nauplii revealed that all T. bellirica and T. chebula extracts are nontoxic, thereby indicating their safety as an antimicrobial agent. To determine whether these extracts are suitable for use in medicine, additional testing should be conducted utilising a panel of mammalian cell lines. Taken together, the findings of our study indicate that T. bellirica and T. chebula fruit extracts may be a valuable source of antimicrobial compounds for future research and development in the fight against bacterial infections.