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Background: Antimicrobial resistance is swiftly increasing all over the world. In Africa, it manifests more in pathogenic bacteria in form of antibiotic resistance (ABR). On this continent, bacterial contamination of commonly used herbal medicine (HM) is on the increase, but information about antimicrobial resistance in these contaminants is limited due to fragmented studies. Here, we analyzed research that characterized ABR in pathogenic bacteria isolated from HM in Africa since 2000; to generate a comprehensive understanding of the drug-resistant bacterial contamination burden in this region., Methods: The study was conducted according to standards of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We searched for articles from 12 databases. These were: PubMed, Science Direct, Scifinder scholar, Google scholar, HerbMed, Medline, EMBASE, Cochrane Library, International Pharmaceutical Abstracts, Commonwealth Agricultural Bureau Abstracts, African Journal Online, and Biological Abstracts. Prevalence and ABR traits of bacterial isolates, Cochran's Q test, and the I 2 statistic for heterogeneity were evaluated using MedCalcs software. A random-effects model was used to determine the pooled prevalence of ABR traits. The potential sources of heterogeneity were examined through sensitivity analysis, subgroup analysis, and meta-regression at a 95% level of significance., Findings: Eighteen studies met our inclusion criteria. The pooled prevalence of bacterial resistance to at least one conventional drug was 86.51% (95% CI = 61.247-99.357%). The studies were highly heterogeneous (I 2 = 99.17%; p < 0.0001), with no evidence of publication bias. The most prevalent multidrug-resistant species was Escherichia coli (24.0%). The most highly resisted drug was Ceftazidime with a pooled prevalence of 95.10% (95% CI = 78.51-99.87%), while the drug-class was 3 rd generation cephalosporins; 91.64% (95% CI = 78.64-96.73%). None of the eligible studies tested isolates for Carbapenem resistance. Extended Spectrum β-lactamase genes were detected in 89 (37.2%) isolates, mostly Salmonella spp., Proteus vulgaris, and K. pneumonia. Resistance plasmids were found in 6 (5.8%) isolates; the heaviest plasmid weighed 23,130 Kilobases, and Proteus vulgaris harbored the majority (n = 5; 83.3%)., Conclusions: Herbal medicines in Africa harbor bacterial contaminants which are highly resistant to conventional medicines. This points to a potential treatment failure when these contaminants are involved in diseases causation. More research on this subject is recommended, to fill the evidence gaps and support the formation of collaborative quality control mechanisms for the herbal medicine industry in Africa., (© 2022. The Author(s).)

The high global bacterial infection burden has created need to investigate the neglected potential drivers of pathogenic bacteria, to inform disease prevention. Kampala is facing a proliferation of herbalists, selling herbal medicine (HM), of largely unregulated microbiological quality. We evaluated the bacterial contamination burden in HM sold in Kampala, to support evidence-based redress. The total viable loads (TVL), total coliform counts (TCC), E. coli counts, and prevalence of selected bacterial strains in 140 HM were examined using conventional culture, following the guidelines of World Health Organization (WHO), and Uganda National Drug Authority (NDA). Data were analyzed using D'Agostino-Pearson test, frequencies, proportions, Chi-square, and Mann–Whitney U test with STATA version-15.0. Fifty (35.7%), fifty-nine (42.1%), and twelve (8.6%) HM were unsafe for human use because they exceeded WHO's permissible limits for TVL, TCC, and E. coli counts respectively. Solids had significantly higher mean TVL than liquids. Violation of NDA's guidelines was significantly associated with high TVL. Fifty-nine bacteria, viz., Klebsiella pneumoniae (n = 34; 57.6%), Escherichia. coli (12; 20.3%), Staphylococcus aureus (7; 11.9%), Klebsiella oxytoca (3; 5.1%), Bacillus cereus, Pseudomonas aeruginosa, and Enterobacter spp. (1; 1.7% each), were isolated from 45 (32.1%) samples. These bacteria can cause severe clinical diseases, and promote deterioration of HM potency. [ABSTRACT FROM AUTHOR]

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. 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). 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%) (χ2, P < 0.05). Multidrug-resistant strains with 100% sensitivity to plant extracts were A. baumannii, S. aureus, and P. aeruginosa. 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. [ABSTRACT FROM AUTHOR]