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Pseudomonas aeruginosa  is naturally resistant to many classes of antipseudomonal antibiotics due to the species ability to easily acquire resistance. Plant-based antibacterial agent in combination with the existing antibiotic proposes an alternative treatment regimen for the eradication of resistant bacterial infections. The antibacterial effects of the isolated epicatechin 3-gallate compound from  Euphorbia hirta  in combination with cefepime were investigated  in vitro  against resistant  P. aeruginosa . The fractional inhibitory concentration index of the combination was determined using checkerboard broth microdilution method. Epicatechin 3-gallate combined with cefepime had produced synergistic effect against  P. aeruginosa  (with average FIC index of 0.24). The MIC of epicatechin 3-gallate was effectively reduced to MIC/4, MIC/8, MIC/16, and MIC/32 in the presence of cefepime. Time-kill study of epicatechin 3-gallate combined with cefepime exhibited remarkable bactericidal activity where the eradication of  P. aeruginosa  occurred within 4 h of treatment. Scanning electron micrographs revealed apparent cell membrane damage and leakage of cytoplasmic contents from  P. aeruginosa  cells which eventually led to the cell lysis after the combination treatment of epicatechin 3-gallate and cefepime. The potential of epicatechin 3-gallate to act synergistically with cefepime against clinically resistant  P. aeruginosa  strain possibly will maximize the successful outcomes when choosing empirical antibiotic treatment in hospitals or health care institutions.

evidence-based complementary and alternative medicine

Combination of Epicatechin 3-Gallate from<i> Euphorbia hirta</i> and Cefepime Promotes Potential Synergistic Eradication Action against Resistant Clinical Isolate of<i> Pseudomonas aeruginosa</i>

Combination of Epicatechin 3-Gallate from Euphorbia hirta and Cefepime Promotes Potential Synergistic Eradication Action against Resistant Clinical Isolate of Pseudomonas aeruginosa