Synergistic effect of Piper chaba root extract and synthesized silver nanoparticles with antibiotics against multidrug- resistant uropathogenicbacteria

The widespread availability, irrational use and empirical therapy-based treatment with traditional antibiotics are the main causes of multidrug resistance (MDR) in uropathogenic Escherichia coli (E. coli). In this study, ethanol and aqueous extracts, as well as synthesized silver nanoparticles from Piper chaba roots were combined with four commercially available antibiotics (azithromycin or AZM, furocef, tetracycline or TCN and ciprofloxacin or CIP) at the fractional ratio to enhance their efficacy. The fractional inhibitory concentration (FIC) index was used to estimate the synergistic effect of these combinations of extracts, synthesized nanoparticles and antibiotics. The combinations of PcRE (Np): AZM at a 3:7 ratio, PcRE (Aq): AZM at a 1:9 ratio, and PcRE (Et): CIP at a 5:5 ratio exhibited synergistic effects. Conversely, antagonistic effects were observed with all fractional ratios of TCN, as well as the 5:5, 7:3, and 1:9 ratios of PcRE (Aq): furocef, PcRE (Et): furocef, and PcRE (Np): furocef. The result indicated that PcRE could enhance the efficiency of AZM and CIP. The in silico study found that bioactive compounds of PcREs inhibited the outer membrane protein transporter OmpC and specific efflux pump systems, known as Resistance-Nodulation-Division (RND) systems.