Review Article A Review of Plant-Based Therapies for the Treatment of Urinary Tract Infections in Traditional Southern African Medicine
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Hindawi Evidence-Based Complementary and Alternative Medicine Volume 2021, Article ID 7341124, 20 pages https://doi.org/10.1155/2021/7341124 Review Article A Review of Plant-Based Therapies for the Treatment of Urinary Tract Infections in Traditional Southern African Medicine Ian Cock ,1,2 Nothando Mavuso,3 and Sandy Van Vuuren 3 1 School of Environment and Science, Griffith University, Brisbane 4111, Australia 2 Environmental Futures Research Institute, Griffith University, Brisbane, Australia 3 Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng 2193, South Africa Correspondence should be addressed to Sandy Van Vuuren; sandy.vanvuuren@wits.ac.za Received 30 April 2021; Accepted 9 July 2021; Published 30 July 2021 Academic Editor: Olufunmiso Olusola Olajuyigbe Copyright © 2021 Ian Cock et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Urinary tract infections (UTIs) are amongst the most common bacterial infections globally, with ∼11% of the world’s population contracting at least one infection annually. Several South African plants are used in traditional healing systems to treat UTIs, yet the therapeutic potential of these plants against bacteria that cause UTI remains poorly explored. This study documents southern African plant species used traditionally to treat UTIs. An extensive literature review was undertaken to document the southern African plant species that are used in traditional South African medicine to treat UTIs, thereby highlighting gaps in the current research that require further study. One hundred and fifty-three southern African plant species that are used to treat UTIs were identified. Eighty-five southern African plants were identified as having noteworthy inhibitory activity against the major UTI- causing bacteria. Few of those studies screened against all of the bacterial causes of UTIs, and none of those studies examined the mechanism of action of the plant preparations. Furthermore, many of those studies did not test the toxicity of the plant extracts, so an evaluation of the safety for therapeutic usage was lacking. Substantial further research is to determine their potential for therapeutic use. 1. Introduction anatomical differences between the genders. As the urethra is located closer to the anus and is shorter in women than in Urinary tract infections (UTIs) are amongst the most men, women are substantially more susceptible to infections common human infections globally. Indeed, it has been by uropathogens [5]. Additionally, individual health status estimated that nearly 800 million people (equating to ap- affects the incidence of UTIs. For example, immunocom- proximately 11% of the global population) develop at least promised individuals and sufferers of chronic uncontrolled one UTI in any given year [1, 2]. They are substantially more diabetes mellitus have substantially increased incidences of common in women than in men, with the prevalence in UTIs as their weakened immune systems are unable to ef- women estimated to be approximately five times higher than fectively combat infections [3]. in males [3]. Indeed, it is expected that more than half of Lifestyle and environmental factors also contribute to female population of the world will contract at least one UTI the prevalence of UTIs. Older adults often accumulate in their lifetime, with a substantial proportion experiencing multiple medical conditions, and their treatment and recurrent infections [1]. With the exception of a spike in UTI management regimens may increase the risks of contracting occurrence in women aged 14–24 years old, the prevalence UTIs. In particular, catheterisation substantially increases of UTIs generally increases with age, with the highest in- the incidence of UTIs, especially by Gram-negative bacterial cidence in women over 65 years of age [4]. The difference in pathogens [1]. Indeed, healthcare-associated UTIs have been rates of UTIs between men and women is related to estimated to account for approximately 10% of UTI cases,
2 Evidence-Based Complementary and Alternative Medicine with 75% of these being reported in female patients [6, 7]. occasionally also cause UTIs. For example, Staphylococcus Additionally, prolonged antibiotic usage to treat other aureus induces a low number of cases of UTIs, although medical conditions weakens the immune response, thereby these are generally considered a special case as they are increasing the susceptibility to UTIs. In younger women, usually secondary to blood S. aureus infections. UTIs can increased sexual activity between the ages of 18 to 39 years of also be caused by fungal and viral pathogens, albeit with a age increases both the incidence of UTIs and the frequency substantially lower prevalence than reported for bacterial of recurrence [4]. Any region of the urinary tract may be- UTIs. In this review, we focus on the major bacterial causes come infected, including the kidneys, bladder, urethra, and of UTIs. Therefore, whilst numerous studies have screened ureter [8]. When the UTIs occur in the lower regions of the traditional medicines for the ability to inhibit S. aureus, urinary tract, the infection is known as a bladder infection those studies generally focussed on other diseases (e.g., skin (cystitis). Infections in the upper urinary tract (pyelone- disorders), and we have not listed those studies herein due to phritis) are commonly referred to as kidney infections. the minor role of this bacterium in inducing UTIs. Likewise, Candida albicans infections are a common cause of urethra infections and are thus commonly classed as urethritis rather 1.1. Types of Urinary Tract Infections. Urinary tract infections than a UTI. Therefore, we do not include studies examining are classified as either complicated or uncomplicated. the effects of southern African plants to inhibit C. albicans Complicated infections occur in people with underlying growth in this review. Numerous other studies have ex- conditions or abnormalities in any part of the genitourinary amined the effects of southern African plants against tract, making the infection more serious and more chal- C. albicans, and the reader is directed to those studies lenging to treat than uncomplicated infections. In contrast, [11–13]. Notably, those studies generally screened against uncomplicated UTIs are classified as infections occurring in C. albicans for reasons not associated with UTIs. the absence of comorbidities or other anatomical urinary The pathogens that cause UTIs usually enter the urinary tract and renal abnormalities [9]. The incidence of com- tract via the urethra. Bacteria are transferred to the urethra plicated UTIs is substantially lower than that of uncom- from the bowel. When they colonise the bladder, they attach plicated UTIs, which occur in otherwise healthy people with to the bladder wall and form a biofilm, which helps the normal genitourinary tract anatomy [10]. However, un- pathogens to evade the host’s immune response [14]. Im- complicated infections are generally easier to manage, and proper urogenital area hygiene, sexual intercourse, and treatment with a short course of antibiotics is usually ef- exposure to unfavourable hygiene products (e.g., scented fective. Urinary tract infections in children and males are and chemical filled feminine products and contraceptives) generally categorised as uncomplicated infections due to may aid in the introduction of pathogens to the urinary tract their low probability of comorbidities [8]. Notably, com- and create suitable growth conditions for infections to de- plicated UTI-causative pathogens are linked to increased velop [10]. Other risk factors for contracting an uncom- rates of antimicrobial resistance. Therefore, the development plicated UTI include sexual intercourse with a new sexual of effective therapies to treat these conditions is vital, not partner, use of contraceptives, and a history of previous only to decrease the effects of these infections, but also to recurrent UTIs. Risk factors for complicated UTIs are un- slow the development of further antibiotic-resistant bacterial derlying diseases, use of catheters, abnormal genitourinary strains. anatomy and physiology, hospitalisation, and exposure to antibiotics [10]. 1.2. Causes of Urinary Tract Infections. Interestingly, there can be notable differences between the infectious agents 1.3. Symptoms of Urinary Tract Infections. Urinary tract responsible for uncomplicated and complicated UTIs. The infections may present in several ways including increased vast majority of these pathogens are normal components of and persistent urgency to urinate, painful burning sensations the gastrointestinal or vaginal microflora, thereby increasing associated with urination, increased frequency of urination, the chances that they cause UTIs. For both classes of UTI, lower volumes for each urinary event, and cloudy and foul uropathogenic Escherichia coli are the leading infective smelling urine. Pain in the lower abdomen, back, and pelvic agent, accounting for approximately 75 and 65% for un- area is also a relatively common symptom of UTIs, especially complicated and complicated UTIs, respectively [1]. Kleb- in women [8]. Occasionally, UTIs may result in blood in the siella pneumoniae accounts for a further 6% and 8% of urine, which may present as red-, pink-, or cola-coloured uncomplicated and complicated UTIs. The bacterium urine. Infection in the kidney may present with symptoms Staphylococcus saprophyticus causes about 6% of uncom- including nausea and vomiting, fever, and upper back pain plicated UTIs yet does not significantly contribute to (most commonly on a single side) [10]. Many of these signs complicated UTIs. In contrast, Enterococcus spp. contribute and symptoms are generic, and UTIs are frequently over- substantially to complicated UTI cases (∼11%), yet con- looked or misdiagnosed as other conditions, particularly in tribute less to uncomplicated UTIs (∼6%). Other bacteria older people. also contribute significantly, albeit with substantially lower rate, to the incidence of UTIs. In particular, Proteus spp. (particularly Proteus mirabilis) and Pseudomonas aeruginosa 1.4. Current Treatments. In most cases, UTIs are relatively each cause approximately 2% of both uncomplicated and easy to treat with a course of broad-spectrum antibiotics, complicated cases of UTIs. Other pathogens may although fluoroquinolones (including ciprofloxacin) are
Evidence-Based Complementary and Alternative Medicine 3 generally avoided as the side effects are often regarded as documented, although many of the therapies are yet to be outweighing the benefits. The most common treatments extensively studied and verified, and substantially more include trimethoprim/sulfamethoxazole, fosfomycin, work is needed in this field. nitrofurantoin, cephalexin, and ceftriaxone. However, due to It is estimated that approximately 700,000 tons of plant overuse and misuse of commonly used clinical antibiotics, materials are used each year in South Africa to produce the emergence of antibiotic-resistant pathogens is increas- herbal remedies worth 1.2 to 2.5 billion South African Rands ingly common, resulting in the failure of the main antibiotic annually [25–28]. Not only are these products widely used in chemotherapy options [15]. Antibiotic resistance has been a South Africa by practitioners of traditional medicine, but driving force of new drug development initiatives, and they are also becoming increasingly popular as comple- implementation of alternative treatment identification and mentary and alternative medicines in combination with new antibiotic therapies are urgently required. allopathic pharmaceuticals. Indeed, some plant products The development of antibiotic-resistant bacteria is in- (e.g., Harpagophytum procumbens (Burch.) DC. Ex Meisn., creasingly resulting in antibiotic therapy failures, and commonly known as devil‘s claw extracts) are commonly chronic UTIs are becoming more frequent [1]. Additionally, sold at pharmacies globally, and it is no longer necessary to the relatively high rate of UTI recurrence poses a challenge visit a traditional Muthi market to obtain products devel- to the effective treatment of these infections [16]. Indeed, oped from them. However, a substantial portion of tradi- that study estimated that approximately 24% of people tional plant use in South Africa does use plant materials contracting a UTI will develop a recurrent infection within obtained and prepared following traditional methods. six months of the original infection. Of further concern, Depending on the plant species used, a variety of different approximately 5% of people who develop a UTI will ex- parts including roots, flowers, leaves, bulbs, and stems may perience more than three recurrences per year [17]. be used medicinally, and the individual parts may have Foxman and Buxton [18] suggest that empirical treat- substantially different properties and uses [29]. Traditional ments of UTIs should be reconsidered due to the following beliefs have a deep influence within the majority of the reasons: ethnic cultures in South Africa and are particularly prevalent in rural communities [30]. Even in urban communities, a (i) The frequency of antibiotic-resistant E. coli strains, large portion of the South African population is reliant on many of which have resistance to multiple antibiotics traditional medicine as their primary mode of healthcare including fluoroquinolones [15], is increasing. The [31]. Indeed, that study postulated that the demand for increasing incidence of extended spectrum β-lacta- traditional medicines in South Africa will increase in future mase (ESBL) UTI pathogens that are resistant to the years due to stress associated with urban lifestyles. commonly used β-lactam class of antibiotics is Despite their widespread use, there is a relative lack of particularly concerning [19, 20]. information on the proper use and preservation of plant (ii) Even relatively short courses of currently used an- medicines. Medicinal plants are considered (often errone- tibiotic therapies may significantly affect the gut ously) to have fewer adverse effects [32] and are often more microflora, resulting in other health issues devel- accessible and affordable than Western/allopathic medica- oping [21]. These therapies may also disrupt the tions [33]. A substantial number of South Africans (espe- urogenital microbiome, resulting in other unfore- cially rural populations) are dependent on self-medication seen issues. Thus, the benefits of empirical antibiotic with plant-based medicines, and the involvement of the therapy may not outweigh the risks [22, 23]. New community in managing the use and preservation of plant and innovative strategies to prevent UTI recurrences species may result in successful strategies for sustainable use and alternative therapies for their treatment are [34]. South African ethnobotanical literature has been rel- considered a high priority [18]. atively well recorded, although the medicinal properties of many species used traditionally are yet to be rigorously verified. There has been a substantial increase in studies 1.5. The Use of Medicinal Plants in Urinary Tract Infection screening and validating the use of South African traditional Treatment. The launch and development of the WHO medicines in recent years, highlighting the potential of Traditional Medicine Strategy 2014–2023 aimed to support several species [35]. Of the therapeutic properties examined, the development and implementation of proactive policies the antibacterial activity of South African plants has received and action plans to improve the role traditional medicine the most attention, although many species remain relatively plays in population health [24]. The strategy focuses on neglected. Numerous plants have been reported to have developing new health systems (including the use of com- antimicrobial activity, with a substantial recent increase in plementary and traditional medicinal products) as a high interest in this field. However, very few of those studies have priority. A re-examination of traditional medicines is an specifically focussed on UTIs. Instead, screening against attractive option for the development of new therapies to bacterial pathogens that cause gastrointestinal diseases treat pathogenic infections as plant-derived medicines have [36, 37], skin disease [38, 39], or autoimmune diseases often been used for hundreds (in some cases, thousands) of [40, 41] have received far greater attention. Notably, many of years. Furthermore, the traditional use by some cultures has the same bacterial species screened in the other studies are been relatively well documented. Asian, Middle Eastern, and also amongst the pathogenic causes of UTIs. Whilst the African traditional systems are perhaps the most extensively focus of those studies is not UTIs, they are included in this
4 Evidence-Based Complementary and Alternative Medicine study as they were screened against the same bacterial (v) Only studies screening against the common causes species. of UTIs were evaluated in this review, irrespective of their focus. For example, studies that screened 2. Materials and Methods southern African plants against E. coli were in- cluded in this study, even if their focus was on This study aimed to record and document the southern gastrointestinal diseases rather than UTIs. African medicinal plants that are used traditionally to treat (vi) Ethnobotanical studies on the flora of southern UTIs. A variety of ethnobotanical books [42–46], as well as African region included South Africa and those multiple peer reviewed journal articles, were consulted to countries immediately surrounding it. compile this list. The online resources Google Scholar, PubMed, Scopus, and ScienceDirect were used to identify and access original scientific research studies. The following 2.3. Exclusion Criteria. The following criteria were used to terms were used as filters and were searched for both alone exclude some studies: and as combination: “Southern Africa,” “South African,” (i) Where name changes and families of plant species “Lesotho,” “Swaziland,” “Namibia,” “Botswana,” “Zim- were encountered, particularly in older publica- babwe,” “Zambia,” “Mozambique,” “traditional medicinal tions, websites such as The Plant List (http://www. plant,” “ethnobotany,” “urinary tract infection,” “UTI,” theplantlist.org/) and South African National Bio- “bladder,” and “uropathogens.” The initial search aimed to diversity Institute (SANBI) (http://www.sanbi.org) document all of the plant species used in southern Africa to were used to confirm species identification. treat UTIs. Our study was nonbiased and did not favour the traditional knowledge of one ethnic group over others. (ii) Plant species that were recorded to treat generic Despite this, substantially more information was available symptoms of UTIs that are common to other ill- about Zulu traditional medicine due to the prevalence of nesses, without specifically stating their use in reports on that topic in the available literature. Whilst most treating UTIs, were excluded from this study. of these species are native South African plants, introduced (iii) Studies that screened against bacteria that only species were not excluded, where they had been incorpo- cause UTIs secondary to other diseases were ex- rated into the traditional medicine systems of at least one cluded. Therefore, studies screening South African South African ethnic group. Following the initial literature plants for S. aureus, which only causes UTIs sec- review, a further review was undertaken to identify the ondary to blood S. aureus infections, were not in- species that have been screened for their ability to inhibit one cluded in this study. or more of the bacterial pathogens that cause UTIs. (iv) Only screening studies that tested against bacterial pathogens were included in this study. Publications 2.1. Eligibility Criteria. Ethnobotanical books and peer that screened South African plants for fungi, viruses, reviewed journal articles were searched using the specific key or protozoa were excluded. words noted above. Published studies were identified and (v) The use of introduced plant species were excluded their abstracts were read to establish their relevance to this from this study unless they are extensively used as study. The full content of publications that were deemed part of southern African traditional medicine of at relevant were then examined thoroughly to ensure that the least one South African ethnic group. eligibility criteria were met. 2.4. Data Collection. A thorough literature search for 2.2. Inclusion Criteria. The following inclusion criteria for publications on southern African medicinal plants used eligibility of the study were considered: traditionally to treat UTIs was undertaken and is sum- (i) Publications written in English and prior to April marised in this study. Additionally, in vivo and in vitro 2021 were used in this review. biological screening of South African medicinal plants for bacterial pathogens that cause UTIs are summarised, re- (ii) Our study was nonbiased and without any taxo- gardless of the origin of the study. The following data was nomic preference. collected for each species: (iii) For the ethnobotanical survey (Table 1), only plant species that are recorded to treat UTIs are included. (i) Species name, family name, and common name for Any plants recorded to treat individual nonspecific each species recorded in the individual publications symptoms were excluded unless it could be deter- were collected mined that they were specifically used to treat UTIs. (ii) Common names and the names used by different (iv) For the biological activity studies presented in Ta- ethnic groups (where appropriate) were collected ble 2, only studies that screened against the major from individual publications and from the SANBI bacterial causes of UTIs were included, irrespective red list website of whether the focus of the study was UTIs or the (iii) The plant part used, method of preparation, and bacteria tested were selected because of their as- mode of administration were recorded where that sociation with a different disease. information was provided
Evidence-Based Complementary and Alternative Medicine 5 Table 1: Southern African plants traditionally used to treat urinary tract infections. Part of plant Plant species Family Common name Uses References used Acacia sieberiana var. woodii Paperbark thorn (Eng); Bark and Urinary tract Leguminosae [46] (Burtt Davy) Keay & Brenan papierbasdoring (Afr) roots ailments Acokanthera oppositifolia Urinary tract Apocynaceae Inhlungunyembe (Zulu) Not specified [43] (Lam.) Codd infection Afroaster hispida (Thunb.) Asteraceae Udlutshana (Zulu) Not specified Urinary ailments [47] J.C.Manning & Goldblatt Agathosma betulina Buchu (Eng); boegoe (Afr); bocho Bladder and Rutaceae Leaves [45, 48, 49] (P.J.Bergius) Pillans (Sotho) kidney ailments Agathosma capensis (L.) Spicy buchu (Eng); anysboegoe, Rutaceae Leaves Urinary ailments [50] Dummer steenbokboegoe (Afr) Agathosma serratifolia Langblaarboegoe, kloofboegoe Bladder and Rutaceae Leaves [45] (Curtis) Spreeth (Afr); long buchu (Eng) kidney ailments Albizia adianthifolia (Schum.) Isiyengelele, usolo, Urinary tract Leguminosae Not specified [47] W.Wight umgadankawu (Zulu) infection Bitteraalwyn (Afr); bitter aloe Leaves, roots, Kidney and Aloe ferox Mill. Xanthorrhoeaceae [51] (Eng) and stems bladder ailments Sebra-aalwyn (Afr); zebra aloe Urinary and Aloe zebrina Baker Xanthorrhoeaceae Leaves [46] (Eng) bladder ailments Antiphiona pinnatisecta Compositae Unknown Roots Bladder ailments [46] (S.Moore) Merxm. Antizoma angustifolia Kidney and Menispermaceae Maagbitterwortel (Afr) Roots [52] (Burch.) Miers ex Harv. bladder ailments Aptosimum procumbens Scrophulariaceae Brandbos (Afr) Leaves Bladder ailments [42–44] (Lehm.) Burch. ex Steud Arctopus echinatus L. Apiaceae Platdoring (Afr) Roots Bladder ailments [42–44, 53] Alsem (Afr); African wormwood Leaves, roots, Bladder and Artemisia afra Jacq. ex Willd. Compositae [49, 51] (Eng); mhlonyana (Zulu) and stems kidney ailments Bush asparagus, African Bladder and Asparagus africanus Lam. Asparagaceae asparagus (Eng); katdoring (Afr); Not specified [46] kidney ailments isigobo (Zulu) Asparagus asparagoides (L.) Urinary tract Asparagaceae Makholela (Sotho) Roots [48] Druce infection Aster bakerianus Burtt Davy Urinary tract Compositae Idlutshane, uhloshana (Zulu) Leaves [43] ex C.A.Sm. infection Baccharoides adoensis var. Stems and Urinary tract kotschyana (Sch.Bip. ex Compositae Innyathelo (Zulu) [43] leaves infection Walp.) Bladder and Ballota africana (L.) Benth. Lamiaceae Kattekruid (Afr) Leaves [50] kidney ailments Ikhakhasi, umalumvuba (Zulu); Urinary and Berkheya Setifera DC. Compositae Root [47, 54] leleme-la-khomo (Sotho) kidney ailments Bolusanthus speciosus (Bolus) Umholo (Zulu); tree wisteria Barks, leaves, Leguminosae Kidney ailments [55] Harms (Eng); vanwykshout (Afr) and stems Boophone disticha (L.f.) Herb. Amaryllidaceae Gifbol (Afr) Bulb Bladder ailments [42–44] Climbing onion (Eng); Bowiea volubilis Harv. Asparagaceae Bulb Bladder ailments [43, 48] knolklimop (Afr); iguleni (Zulu) Brachylaena discolor DC. Compositae Bosvaalbos (Afr); ipahla (Zulu) Leaves Urinary ailments [43] Bulbine abyssinica A.Rich Xanthorrhoeaceae Wildekopieva (Afr) Leaves Bladder ailments [56, 57] Bladder and Bulbine latifolia (L.f.) Spreng. Xanthorrhoeaceae Red carrot (Eng); rooiwortel (Afr) Root [48, 57] kidney ailments Cardiospermum halicacabum Balloon vine (Eng); blaasklimop Stems and Sapindaceae Bladder ailments [43, 46, 58] L. (Afr) leaves Carica papaya L. Caricaceae Papaya, pawpaw (Eng) Not specified Bladder ailments [42] Buffalograss (Eng); bloubuffelgras Urinary tract Cenchrus ciliaris L. Poaceae Roots [43, 59, 60] (Afr); idungamuzi (Zulu) infection Urinary and Centaurea benedicta (L.) L. Compositae Karmedik (Afr) Not specified [50] kidney ailments Chironia baccifera L. Gentianaceae Bitterbos, sarsaparilla (Afr) Not specified Urinary ailments [50]
6 Evidence-Based Complementary and Alternative Medicine Table 1: Continued. Part of plant Plant species Family Common name Uses References used Chrysanthemoides monilifera Urinary and Compositae Bietou, bessiebos (Afr) Whole plant [50] (L.) Norl. kidney ailments David’s root (Eng); gifhondjie, Roots and Cissampelos capensis L.f. Menispermaceae Bladder ailments [42–44, 46] dawidjieswortel (Afr) leaves African cabbage, spiderwisp Cleome gynandra L. Cleomaceae Not specified Bladder ailments [42] (Eng); snotterbelletjie (Afr) Wildewingerd (Afr); wild vine Cliffortia odorata L.f. Rosaceae Leaves Bladder ailments [48] (Eng) Benediction lily (Eng); boslelie Clivia miniata (Lindl.) Bosse Amaryllidaceae Bulb Urinary ailments [43] (Afr); umayime (Zulu) Coix lacryma-jobi L. Poaceae Job’s tears, adlay (Eng) Not specified Bladder ailments [42] Umduba, umdubu omhlophe, Urinary and Combretum kraussii Hochst. Combretaceae Not specified [47] umdubo wamanzi (Zulu) bladder ailments Idangabane (Zulu); khopo Commelina africana L. Commelinaceae Root Bladder ailments [43] (Sotho) Conostomium natalense Wild pentas (Eng); umbophe, Rubiaceae Not specified Urinary ailments [61] (Hochst.) Bremek. ungcolosi (Zulu) Conyza scabrida DC. Compositae Oondbos, bakbos, paddabos (Afr) Leaves Bladder infection [51] Crinum macowanii Baker Amaryllidaceae River fly (Eng); umduze (Zulu) Bulb Urinary ailments [43] Crinum moorei Hook. f. Amaryllidaceae Umduze (Zulu) Bulb Urinary ailments [43] Crossyne guttata (L.) D.Müll.- Amaryllidaceae Gifbol (Afr) Bulb Bladder ailments [42–44] Doblies & U.Müll.-Doblies Cryptolepis oblongifolia Bokhoring, melkbos (Afr); Apocynaceae Not specified Bladder ailments [42] (Meisn.) Schltr. mukangaza (Sotho) Cussonia paniculata Eckl. & Kidney and Araliaceae Motsetse (Sotho) Not specified [54, 62] Zeyh. bladder ailment Cyathula achyranthoides Amaranthaceae Unknown Not specified Bladder ailments [63] (Kunth) Moq. Dog’s tooth (Eng); krookgras Cynodon dactylon (L.) Pers. Poaceae Rhizome Urinary ailments [46] (Afr) Thornapple, jimsonweed, devil’s Datura stramonium L. Solanaceae Leaves Bladder ailments [42] snare (Eng) Bladder and Dicoma capensis Less. Compositae Karmedik, wilde karmedik (Afr) Leaves [44, 45, 56, 57] kidney ailments Bladder and Diosma oppositifolia L. Rutaceae Buchu, Bitter buchu (Eng) Leaves [48] kidney ailments Urinary and Diosma prama I.Williams Rutaceae Steenbokkboegoe (Afr) Not specified [50] kidney ailments Diospyros mespiliformis Ikhambi lesduli, umazambezi Ebenaceae Not specified Urinary ailments [47] Hochst. ex A.DC (Zulu) Dipcadi gracillimum Baker Asparagaceae Oumasegroottoon (Afr) Not specified Bladder ailments [63] Ugibizisila, uguleni, Urinary tract Dipcadi viride (L.) Moench Asparagaceae Not specified [47] umakhweyana (Zulu) infection Dipcadi gracillimum Baker Asparagaceae Oumasegroottoon (Afr) Not specified Urinary ailments [64] Basterolen, sandolien, ysterbos Bladder and Dodonaea viscosa (L.) Jacq. Sapindaceae Leaves [5, 50, 51] (Afr); sand olive (Eng) kidney ailments Satin squill (Eng); brandui, Drimia elata Jacq. Asparagaceae Not specified Urinary ailments [44] jeukbol (Afr); umqumbu (Zulu) Dysphania ambrosioides (L.) Ikhambi leslumo, Amaranthaceae Not specified Urinary ailments [47] Mosyakin & Clemants uzansikwesibaya (Zulu) Elytropappus rhinocerotis Bladder and Asteraceae Renosterbos (Afr) Leaves [49] (L.f.) Less. kidney disorders Elymus repens (L.) Gould Poaceae Couch grass (Eng) Not specified Bladder ailments [42] Empleurum unicapsulare Bergboegoe, langblaarboegoe Urinary and Rutaceae Whole plant [50] (L.f.) Skeels (Afr) kidney ailments Urinary and Eriocephalus punctulatus DC. Compositae Kapokbos (Afr) Whole plant [50] kidney ailments Eriosema distinctum N.E.Br. Leguminosae Ubangalala omkhulu (Zulu) Roots Urinary ailments [43]
Evidence-Based Complementary and Alternative Medicine 7 Table 1: Continued. Part of plant Plant species Family Common name Uses References used Coral tree (Eng); kaffirboom Erythrina caffra Thunb. Leguminosae Leaves Urinary ailments [43] (Afr); umsinsi (Zulu) Erythrina lysistemon Hutch. Leguminosae Umsinsi (Zulu) Leaves Bladder ailments [47] Urinary tract Euclea natalensis A.DC. Ebenaceae IsiZimane, umshekisane (Zulu) Bark [47, 65] infection Ghwarrie, ghwarrieboom, Urinary and Euclea undulata Thunb. Ebenaceae Whole plant [43, 50] ghwarriebos (Afr) kidney ailments Eucomis autumnalis (Mill.) Asparagaceae Mathethebane (Sotho) Tubular roots Urinary ailments [58] Chitt Euphorbia milii Des Moul. Euphorbiaceae Crown of thorns (Eng) Not specified Bladder ailments [64, 66] Euphorbia tithymaloides L. Euphorbiaceae Redbird flower (Eng) Not specified Bladder ailments [64, 66] Exomis microphylla (Thunb.) Amaranthaceae Hondepisbos, hondebossie (Afr) Whole plant Urinary ailments [50] Aellen Faidherbia albida (Delile) Leguminosae Anatree (Eng); anaboom (Afr) Bark Bladder ailments [46] A.Chev. Vinkel, makuinkel, soetvinkel Foeniculum vulgare Mill. Apiaceae Whole plant Urinary ailments [50] (Afr) Galenia africana L. Aizoaceae Kraalbos (Afr) Leaves Bladder ailments [42–44] Red storm (Eng); rooistorm, Galium tomentosum Thunb. Rubiaceae Root Bladder ailments [48, 56] doodlief (Afr) Carpet geranium (Eng); horlosie, Geranium incanum Burm.f. Geraniaceae bergtee, vrouetee (Afr); tlako Not specified Bladder ailments [56, 64] (Sotho) Grewia caffra Meisn. Malvaceae Upata, iphatha (Zulu) Roots, bark Bladder ailment [67] Cross berry (Eng); iklolo, Grewia occidentalis L. Malvaceae Roots Bladder ailments [43] imahlehle (Zulu) Grewia robusta Burch. Malvaceae Bokbos (Afr) Whole plant Urinary ailments [50] Gunnera perpensa L. Gunneraceae Ugobho, izibu (Zulu) Not specified Bladder ailments [47] Helichrysum crispum (L.) Bladder and Compositae Kooigoed (Afr) Leaf [49] D. Don kidney ailments Helichrysum odoratissimum Phefo (Sotho); kooigoed, kooibos Leaves, roots, Compositae Bladder ailments [50, 56] (L.) Sweet (Afr) and stems Helichrysum patulum (L.) Honey everlasting (Eng); Compositae Not specified Bladder ailments [42] D.Don kooigoed (Afr); impepho (Zulu) Hibiscus pusillus Thunb. Malvaceae Blaasbossie (Afr) Whole plant Urinary ailments [50] Stems and Hibiscus mastersianus Hiern Malvaceae Monarch rosemallow (Eng) Urinary ailments [46] Leaves Pink mallow (Eng); indola Hibiscus pedunculatus L.f. Malvaceae Leaves Urinary ailments [43] ebomvu (Zulu) Bird gooseberry (Eng); Hoslundia opposita Vahl Lamiaceae Not specified Urinary ailments [46] uyaweyawe (Zulu) Hypoxis hemerocallidea Hypoxidaceae Inkanfe (Zulu); yellow star (Eng) Not specified Bladder ailments [47, 50] Fisch., C.A.Mey. & Avé-Lall. Ilabatheka, inkomfe, umhungulo Hypoxis rigidula Baker Hypoxidaceae Not specified Bladder ailments [47, 50] (Zulu); African potato (Eng) Indigofera cassioides DC. Leguminosae Unknown Not specified Bladder ailments [42] Beach morning glory, goat’s foot Ipomoea pes-caprae (L.) R.Br. Convolvulaceae Not specified Bladder ailments [42] (Eng); strandpatat (Afr) Jasminum abyssinicum Oleaceae Mthundangazi Roots Bladder ailments [68] Hochst. ex DC. Tubular roots Urinary tract Kedrostis capensis A. Meeuse Cucurbitaceae Sesepa sa linoha (Sotho) [69] and leaves infection Ledebouria marginata (Baker) Urinary tract Asparagaceae Bokhoe (Sotho) Root bulb [70] Jessop infection Stems with Bladder and Leonotis leonurus (L.) R.Br. Lamiaceae Klip dagga, wild dagga (Afr) leaves and [49] kidney disorders, flowers Lessertia frutescens (L.) Kidney and Leguminosae Kalkoenblom, keurtjie (Afr) Leaves [50, 56] Goldblatt & J.C.Manning urinary ailments
8 Evidence-Based Complementary and Alternative Medicine Table 1: Continued. Part of plant Plant species Family Common name Uses References used Matricaria chamomilla L. Compositae Chamomile (Eng) Not specified Bladder ailments [42] Urinary tract Melianthus pectinatus Harv. Melianthaceae Kriekiebos, lidjiebos (Afr) Root [56] infection Wild mint (Eng); ufuthana Bladder and Mentha longifolia (L.) L. Lamiaceae Leaves [49, 52, 68] lomhlanga (Zulu) kidney ailments Merwilla plumbea (Lindl.) Inguduza, untabosizi, untangana Asparagaceae Not specified Bladder ailments [47, 50] Speta zibomvana (Zulu) Mesembryanthemum Aizoaceae Ibohlololo (Zulu) Leaves Bladder ailment [44, 47, 53] cordifolium L.f. Common ice plant, crystalline ice Mesembryanthemum Aizoaceae plant (Eng); soutslaai, Not specified Bladder ailments [42] crystallinum L. volstruisslaai (Afr) Mikania capensis DC. Compositae Umdlonzo, umhlozo (Zulu) Leaves Urinary ailments [42, 43] Millettia oblata Dunn Leguminosae Unknown Roots Bladder ailments [42] Notobubon galbanum (L.) Blister bush (Eng); bergseldery Kidney and Apiaceae Not specified [42, 52] Magee (Afr) bladder ailment Blue water lily (Eng); Urinary tract Nymphaea nouchali Burm.f. Nymphaeaceae blouwaterlelie (Afr); izubu, iziba, Leaves [46, 47, 49] infection ugobho (Zulu) Hoary basil (Eng); wilde Urinary tract Ocimum americanum L. Lamiaceae Not specified [46] basielkruid (Afr) infection Ocotea bullata (Burch.) Stinkwood, laurel wood (Eng); Lauraceae Bark Urinary ailments [43, 58] E. Meyer in Drege umnukani, umhlungulu (Zulu) Wild olive (Eng); olyfhout, Roots and Urinary tract Olea europaea L. Oleaceae olienhout (Afr); isadlulambezo [43, 46] bark infection (Zulu) Snuff-box tree (Eng); Oncoba spinosa Forssk. Salicaceae Not specified Bladder ailments [42] snuifkalbassie (Afr) Foie e kubedu (Sepedi); mudoro Opuntia ficus-indica (L.) Mill. Cactaceae Roots Urinary ailments [63] (Venda) Pedalium murex L. Pedaliaceae Large caltrops (Eng) Leaves Bladder ailments [42] Leaves and Bladder and Pegolettia baccharidifolia Less. Compositae Ghwarrieson, heuningdou (Afr) [44, 45] twigs kidney ailments Pelargonium grossularioides Rooirabas (Afr); gooseberry- Leaves and Urinary tract Geraniaceae [51, 68] (L.) L’Hér. leaved Pelargonium (Eng) stems infection Pelargonium hypoleucum Urinary tract Geraniaceae Rooirabas (Afr) Roots [56] Turcz. infection Pelargonium ramosissimum Leaves and Bladder and Geraniaceae Dassieboegoe, dassiebos (Afr) [51, 68] Willd. stems kidney ailments Pentanisia prunelloides Sooibrandbossie (Afr); Bladder and Rubiaceae Roots [43] (Klotzsch) Walp. icimamlilo (Zulu) kidney ailments Petroselinum crispum (Mill.) Apiaceae Pietersielie (Afr); parsley (Eng) Leaves Bladder ailments [49, 66] Nyman ex A.W.Hill. Inkbessie (Afr); ingubivumile Phytolacca heptandra Retz. Phytolaccaceae Not specified Urinary ailments [43] (Zulu) Pigweed, wild purslane (Eng); Bladder and Portulaca quadrifida L. Portulacaceae Not specified [42, 46] kanniedood (Afr) kidney ailments Prunus persica (L.) Batsch Rosaceae Peach (Eng) Leaves Bladder ailments [42] Botterblom, brandblare (Afr); Ranunculus multifidus Forssk. Ranunculaceae Leaves Urinary ailments [43] uxhaphozi (Zulu) Kidney and Rhamnus prinoides L’Hér. Rhamnaceae Mofifi (Sotho) Root [54] bladder ailment Wild/bitter grape (Eng); Rhoicissus tridentata (L.f.) Vitaceae bobbejaantou, wildedruif (Afr); Stems Urinary ailments [43, 64] Wild & R.B.Drumm. isinwazi (Zulu) Rhynchosia caribaea (Jacq.) Snoutbean (Eng); rankboontjie Leguminosae Roots Urinary ailments [46] DC. (Afr); isihlahlasenqomfi (Zulu) Least snoutbean, burn-mouth- Rhynchosia minima (L.) DC. Leguminosae Roots Bladder ailments [46] vine (Eng)
Evidence-Based Complementary and Alternative Medicine 9 Table 1: Continued. Part of plant Plant species Family Common name Uses References used Rhynchosia sublobata Leguminosae Twiner of barren ground (Eng) Roots Bladder ailments [46] (Schum.) Meikle Urinary and Ricinus communis L. Euphorbiaceae Olieboom, olieblaar (Afr) Leaves [47, 50] kidney ailments Rotheca hirsuta (Hochst.) Butterfly bush, wild violet (Eng); Lamiaceae Not specified Urinary ailments [64] R.Fern umathanjana, lusikisiki (Zulu) Urinary tract Ruta graveolens L. Rutaceae Wynruit (Afr) Leaves infection and [49, 56] bladder ailments Salix woodii Seemen Salicaceae Wild willow (Eng) Bark Urinary ailments [69] Cape willow (Eng); vaalwilger Salix mucronata Thunb. Salicaceae Bark Bladder ailments [46] (Afr) Toothbrush tree, real mustard Urinary tract Salvadora persica L. Salvadoraceae Roots [46] tree (Eng); kerriebos (Afr) infection Baby sage, Graham’s sage, Salvia microphylla Kunth Lamiaceae Roots Urinary ailments [50] blackcurrant sage (Eng) Scadoxus puniceus (L.) Friis & Idumbe likahloyile, uhloyile, Amaryllidaceae Not specified Urinary ailments [47] Nordal umphompo (Zulu) Urinary tract Gifappel (Afr); umthuma, Solanum aculeastrum Dunal Solanaceae Fruit infection and [47, 48] untumane (Zulu) kidney ailments Sutherlandia frutescens (L.) Leaves and Bladder and Fabaceae Keurtjies, kankerbossie (Afr) [49] R.Br. stems kidney ailments Camphor bush (Eng); wilde Tarchonanthus camphoratus Compositae kanferbos (Afr); igceba elimhlope Not specified Urinary ailments [64] L. (Zulu) Teucrium trifidum Retz. Lamiaceae Katjiedriebaar (Afr) Leaves Bladder ailments [56, 57] Thesium hystrix A.W.Hill Santalaceae Kleinswartstorm (Afr) Roots Bladder ailments [42] Stinging nettle (Eng); ubangalala, Tragia meyeriana Müll.Arg. Euphorbiaceae Not specified Bladder ailments [42, 43] imbabazane (Zulu) Tragia rupestris Sond. Euphorbiaceae Ubangalala, imbabazane (Zulu) Roots Bladder ailments [43] Red rash (Eng); basteressenhout Trichilia emetica Vahl Meliaceae Bark Kidney ailments [43] (Afr); ixolo, umkhuhlu (Zulu) Erasmus clover, wild clover Trifolium africanum Ser. Leguminosae (Eng); wildeklawer (Afr); Not specified Bladder ailments [63] moqoiqoi, moqophi (Sesotho) Typha capensis (Rohrb.) Bladder and Typhaceae Papkuil (Afr) Not specified [46] N.E.Br. kidney ailments Small nettle (Eng); dog nettle Urtica urens L. Urticaceae Bark Bladder pains [58] Eng) Warburgia salutaris Canellaceae Isibaha (Zulu) Leaves Urethral ailments [67] (G.Bertol.) Chiov. Withania somnifera (L.) Winter cherry (Eng); geneesblaar Solanaceae Roots Bladder ailments [46] Dunal (Afr) Xanthium strumarium L. Compositae Kankerroos (Afr) Not specified Bladder ailments [42] Xysmalobium undulatum (L.) Apocynaceae Wild cotton (Eng); melkbos (Afr) Not specified Bladder ailments [46] W.T.Aiton Arum lilies, calla lilies, pig lily Zantedeschia albomaculata Araceae (Eng.); varkblom (Afr); Not specified Urinary ailments [54, 62–64] (Hook.) Baill. mohalalitoe (Sotho) Zea mays L. Poaceae Corn (Eng); umbila (Zulu) Not specified Bladder ailments [42] Microsoft Excel was used for statistical data analysis. traditionally been passed down from generation to gener- ation by word of mouth, and some of this knowledge has 3. Results now been recorded in ethnobotanical publications, although it is likely that substantial information is not yet readily 3.1. Plants Used Traditionally to Treat Urinary Tract Infections. available. A total of 153 plants from fifty-two families were Numerous South African plant species have been recorded recorded in the literature for the treatment of UTIs (Table 1). to treat pathogenic diseases. This knowledge has Out of the fifty-two families, Compositae had the greatest
10 Evidence-Based Complementary and Alternative Medicine Table 2: Plant species with noteworthy activity that have been tested against urinary tract bacterial pathogens. Plant part Pathogens Plant species MIC values Toxicity evaluation References used screened Non-toxic in Artemia Acacia karoo Hayne Leaves E. coli (M) 414 μg/mL; (W) 458 μg/mL [71] lethality assay Root and Root and bark: (E) 780 μg/mL; (W) Acacia nicolitica (L.) Delile E. coli Not determined [72] bark 6250 μg/mL Root and Root and bark: (E) 92–780 μg/mL; (W) Acacia sieberiana DC. E. coli Not determined [72] bark 1560 μg/mL Not toxic in human E. coli (W) > 8000 μg/mL [73] Agathosma betulina (Berg.) epithelial kidney cells Leaves Pillans K. pneumoniae (M) 1876 μg/mL; (W) 2387 μg/mL Non-toxic in Artemia [41] P. mirabilis (M) 878 μg/mL lethality assay [40] Leaves: (M) 63 μg/mL; (E) 63 μg/mL E. coli Stem (M) 63 μg/mL; (E) 63 μg/mL Leaves: (M) 125 μg/mL; (E) 125 μg/mL Alchornea cordifolia K. pneumoniae Leaves, Stem (M) 125 μg/mL; (E) 125 μg/mL (Schumach. And Thonn.) Not determined [74] stem Leaves: (M) 125 μg/mL; (E) 125 μg/mL Müll. Arg. P. mirabilis Stem (M) 125 μg/mL; (E) 250 μg/mL S. Leaves: (M) 63 μg/mL; (E) 63 μg/mL saprophyticus Stem (M) 63 μg/mL; (E) 63 μg/mL Leaves: (M) 125 μg/mL; (E) 125 μg/mL E. coli Roots: (M) 500 μg/mL; (E) 500 μg/mL Stem: (M) 500 μg/mL; (E) 250 μg/mL Leaves: (M) 63 μg/mL; (E) 63 μg/mL K. pneumoniae Roots: (M) 125 μg/mL; (E) 125 μg/mL Leaves, Stem: (M) 500 μg/mL; (E) 500 μg/mL Alchornea laxiflora (Benth.) LC50 � 100–140 μg/mL in roots, Leaves: (M) 8000 μg/mL; (E) 2000 μg/ [74] Pax & Hoffm. HeLa cells stem mL P. mirabilis Roots: (M) 250 μg/mL; (E) 250 μg/mL Stem: (M) 4000 μg/mL; (E) 4000 μg/mL Leaves: (M) 63 μg/mL; (E) 63 μg/mL S. Roots: (M) 63 μg/mL; (E) 63 μg/mL saprophyticus Stem: (M) 63 μg/mL; (E) 63 μg/mL Not toxic in human Aloe ferox Mill. Leaves E. coli (W) > 8000 μg/mL [73] epithelial kidney cells E. coli (M) 1250 μg/mL Aloe marlothii A.Berger Leaves Not determined [75] P. aeruginosa (M) 1250 μg/mL Apodytes dimidiata E.Mey E. coli (A) 2500 μg/mL Not stated Not determined [76] ex am. P. aeruginosa (A) 310 μg/mL Artemisia afra Jacq. Ex Not toxic in human Leaves E. coli (W) 3000 μg/mL [74] Willd. epithelial kidney cells K. pneumoniae (M) 438 μg/mL; (W) 379 μg/mL Non-toxic in Artemia [41] Ballota africana (L.) Benth. Leaves P. mirabilis (M) 4278 μg/mL lethality assay [40] Bolosanthus speciosis LC50 � 53 μg/mL in Vero Leaves E. coli (A) 80 μg/mL [77] (Bolus) Harms cells E. coli (A) 630 μg/mL Brachylaena discolor Not stated Not determined [76] P. aeruginosa (A) 310 μg/mL Calpurnia aurea (aiton) LC50 � 57 μg/mL in Vero Leaves E. coli (A) 40 μg/mL [77] Benth. cells P. mirabilis (M) 205 μg/mL; (W) 561 μg/mL Carpobrotus edulis (L.) N.E. Non-toxic in Artemia Leaves Proteus [40] Br. (M) 670 μg/mL; (W) 1246 μg/mL lethality assay vulgaris Cissius quadrangularis E. coli (M) 1259 μg/mL Stems Not determined [75] (Linn.) P. aeruginosa (M) 2500 μg/mL Clausena anisata (Willd.) E. coli (A) 310 μg/mL Not stated Not determined [76] Hook ex Benth. P. aeruginosa (A) 310 μg/mL Clerodendron glabrum E. coli (A) 310 μg/mL Not stated Not determined [76] E.Mey P. aeruginosa (A) 630 μg/mL
Evidence-Based Complementary and Alternative Medicine 11 Table 2: Continued. Plant part Pathogens Plant species MIC values Toxicity evaluation References used screened Combretum kraussii Root and bark: (E) 1560 μg/mL; (W) Leaves E. coli Not determined [72] Hochst. 3125 μg/mL Cremaspora triflora LC50 � 14 μg/mL in Vero Leaves E. coli (A) 50 μg/mL [77] (Thonn.) K.Schum. cells (M) 4000 μg/mL; (W) > 8000 μg/mL; E. coli (D) > 8000 μg/mL; (EA) > 8000 μg/mL; (H) > 8000 μg/mL Cryptocarya latifolia Sond. Bark Not determined [78] (M) 4000 μg/mL; (W) > 8000 μg/mL; P. aeruginosa (D) > 8000 μg/mL; (EA) 2000 μg/mL; (H) 4000 μg/mL Curtisia dentata (Burm.f ) E. coli (A) 600 μg/mL Not stated Not determined [79] C.A. Sm. P. aeruginosa (A) 600 μg/mL E. coli (M) 1250 μg/mL Cussonia spicata Thunb. Bark Not determined [75] P. aeruginosa (M) 1250 μg/mL E. coli (A) 880 μg/mL Cussonia zuluensis Strey. Not stated Not determined [79] P. aeruginosa (A) 880 μg/mL Cyathea dregei (Kunze.) E. coli (A) 310 μg/mL Not stated Not determined [76] R.M.Tyron P. aeruginosa (A) 310 μg/mL Dicerocaryum ericarpum E. coli (M) 1250 μg/mL Shoots Not determined [75] (Decne.) P. aeruginosa (M) 1250 μg/mL (M) 1000 μg/mL; (W) > 8000 μg/mL; Non-toxic in Artemia Ekebergia capensi Sparrm. Leaves E. coli [80] (D) 1000 μg/mL lethality assay Ekebergia pterophylla (M) 1000 μg/mL; (W) > 8000 μg/mL; Non-toxic in Artemia Leaves E. coli [80] (C.DC) Hofmeyr (D) 4000 μg/mL lethality assay Elaeodendron croceum LC50 � 5 μg/mL in Vero Leaves E. coli (A) 110 μg/mL [77] (Thunb.) DC. cells (M) 1750 μg/mL; (D) 1750 μg/mL; E. coli Euclea crispa (Thunb.) (EA) 1280 μg/mL Leaf Not determined [81] Gürke (M) 2000 μg/mL; (D) 2000 μg/mL; P. aeruginosa (EA) 1500 μg/mL (M) 1250 μg/mL; (D) 1750 μg/mL; E. coli (EA) 1380 μg/mL Euclea natalensis A. DC. Leaf Not determined [81] (M) 1000 μg/mL; (D) 2000 μg/mL; P. aeruginosa (EA) 2000 μg/mL (M) > 8000 μg/mL; (W) > 8000 μg/mL; E. coli (D) > 8000 μg/mL; (EA) > 8000 μg/mL; Eucomis autumnalis (Mill.) (H) > 8000 μg/mL Bulb Not determined [78] Chitt. (M) > 8000 μg/mL; (W) > 8000 μg/mL; P. aeruginosa (D) > 8000 μg/mL; (EA) > 8000 μg/mL; (H) 2000 μg/mL Root and Root and bark: (E) 1560 μg/mL; (W) Ficus sur Forssk. E. coli Not determined [72] bark 4600 μg/mL Gymnosporia senegalensis (M) 156 μg/mL; (W) 312 μg/mL; (E) Roots E. coli Not determined [82] (Lam.) Loes. 156 μg/mL; (A) 312 μg/mL (M) > 8000 μg/mL; (W) > 8000 μg/mL; E. coli (D) > 8000 μg/mL; (EA) > 8000 μg/mL; (H) > 8000 μg/mL Hydnora africana Thunb. Bark Not determined [78] (M) 2000 μg/mL; (W) > 8000 μg/mL; P. aeruginosa (D) > 8000 μg/mL; (EA) > 8000 μg/mL; (H) > 8000 μg/mL Heteromorpha arborescens LC50 � 81 μg/mL in Vero Leaves E. coli (A) 180 μg/mL [77] (Spreng.) Cham & Schltdl. cells Hetromorpha trifoliata E.coli (A) 630 μg/mL Not stated Not determined [76] Wendl. Eckl. & Zeyh. P. aeruginosa (A) 630 μg/mL
12 Evidence-Based Complementary and Alternative Medicine Table 2: Continued. Plant part Pathogens Plant species MIC values Toxicity evaluation References used screened Non-toxic in Artemia Heteropyxis natalensis Harv. Leaves E. coli (M) 382 μg/mL [71] lethality assay Hypericim roeperianum LC50 � 66 μg/mL in Vero Leaves E. coli (A) 130 μg/mL [77] G.W.Schimp. ex A. Rich. cells (M) 4000 μg/mL; (W) 4000 μg/mL; (D) E. coli > 8000 μg/mL; (EA) > 8000 μg/mL; Hypoxis hemerocallidea (H) > 8000 μg/mL Leaves Not determined [78] Fisch.Mey. & avé-Lall. (M) > 8000 μg/mL; (W) > 8000 μg/mL; P. aeruginosa (D) > 8000 μg/mL; (EA) > 8000 μg/mL; (H) > 8000 μg/mL Whole (M) 78 μg/mL; (E) 146 μg/mL; (A) Indigofera daleoides Harv. E. coli Not dertermined [82] plant 78 μg/mL E. coli (A) 160 μg/mL Indigofera frutescens Linn. f. Not stated Not determined [76] P. aeruginosa (A) 310 μg/mL E. coli (M) 630 μg/mL Jatropha zeheri Sond. Root Not determined [75] P. aeruginosa (M) 2500 μg/mL E. coli (M) 827 μg/mL; (W) 681 μg/mL [71] Kigelia africana (Lam.) Non-toxic in Artemia Leaves K. pneumoniae (M) 965 μg/mL; (W) 663 μg/mL [41] Benth. lethality assay P. mirabilis (M) 2483 μg/mL; (W) 285 μg/mL [40] Leucosidea sericea Eckl. & E. coli (A) 80 μg/mL Not stated Not determined [76] Zeyh. P. aeruginosa (A) 20 μg/mL E. coli (M) 439 μg/mL; (W) 192 μg/mL [71] K. pneumoniae (M) 538 μg/mL; (W) 654 μg/mL [41] Lippia javanica (Burm.f.) Non-toxic in Artemia Leaves P. mirabilis (M) 313 μg/mL; (W) 1873 μg/mL [40] Spreng. lethality assay Proteus (M) 926 μg/mL; (W) 1728 μg/mL [40] vulgaris E. coli (A) 40–310 μg/mL LC50 � 2.4 μg/mL in Vero Maesa lanceolata Forssk. Leaves [76, 77] P. aeruginosa (A) 20–310 μg/mL cells Melletia grandis (E.Mey.) E. coli (A) 310 μg/mL Not stated Not determined [76] Skeels P. aeruginosa (A) 310 μg/mL E. coli (A) 310 μg/mL Melia azedarach L. Not stated Not determined [76] P. aeruginosa (A) 630 μg/mL LC50 � 41 μg/mL in Vero Morus mesozygia Stapf. Leaves E. coli (A) 70 μg/mL [77] cells Nymania capensis (Thunb.) (M) > 8000 μg/mL; (W) > 8000 μg/mL; Non-toxic in Artemia Leaves E. coli [80] Lindb. (D) > 8000 μg/mL lethality assay (M) 156 μg/mL; (W) 156 μg/mL; (E) Ozoroa insignis Delile Stem bark E. coli Not determined [82] 156 μg/mL; (A) 156 μg/mL Non-toxic in Artemia Pelargonium sidoides DC. Leaves E. coli (W) > 8000 μg/mL [73] lethality assay Pittosporum viridiflorum LC50 � 55 μg/mL in Vero Leaves E. coli (A) 110 μg/mL [74] Sims cells Pelargonium fasiculata (L.) K. pneumoniae (M) 374 μg/mL; (W) 432 μg/mL Non-toxic in Artemia [41] Leaves Alton P. mirabilis (M) 806 μg/mL; (W) 1843 μg/mL lethality assay [40] E. coli (M) 630 μg/mL Ptaerocarpus angolensis DC. Bark Not determined [75] P. aeruginosa (M) 2500 μg/mL K. pneumoniae (M) 1977 μg/mL [41] Ptaeroxylon obliquim P. mirabilis (M) 239 μg/mL; (W) 487 μg/mL Non-toxic in Artemia Leaves (Thunb.) Radlk. Proteus lethality assay [40] (M) 511 μg/mL; (W) 727 μg/mL vulgaris
Evidence-Based Complementary and Alternative Medicine 13 Table 2: Continued. Plant part Pathogens Plant species MIC values Toxicity evaluation References used screened (M) > 8000 μg/mL; (W) > 8000 μg/mL; E. coli (D) > 8000 μg/mL; (EA) > 8000 μg/mL; Prunus africana (Hook. f.) (H) > 8000 μg/mL Roots Not determined [78] Kalkman (M) > 8000 μg/mL; (W) > 8000 μg/mL; P. aeruginosa (D) > 8000 μg/mL; (EA) > 8000 μg/mL; (H) > 8000 μg/mL (M) 78 μg/mL; (W) 78 μg/mL; (E) Punica granatum L. Roots E. coli Not determined [82] 78 μg/mL; (A) 78 μg/mL Leaves E. coli (M) 400 μg/mL Rhicinus communis Linn. Not determined [75] and stem P. aeruginosa (M) 780 μg/mL Rhoicissus rhomboidea (E. Non-toxic in Artemia Leaves E. coli (M) 306 μg/mL; (W) 333 μg/mL [71] Mey ex Harv.) Planch. lethality assay (M) > 8000 μg/mL; (W) > 8000 μg/mL; E. coli (D) > 8000 μg/mL; (EA) > 8000 μg/mL; Rhoicissus tridentata (L.f.) (H) > 8000 μg/mL Roots Not determined [78] Wild & R.B.Drumm. (M) 2000 μg/mL; (W) > 8000 μg/mL; P. aeruginosa (D) > 8000 μg/mL; (EA) > 8000 μg/mL; (H) > 8000 μg/mL E. coli (A) 13130 μg/mL Riccinus communis L. Leaves P. aeruginosa (M) 14670 μg/mL; (E) 16670 μg/mL Not determined [83] K. pneumoniae (M) 12670 μg/mL; (A) 11670 μg/mL Sacrostemma viminale R. E. coli (M) 1250 μg/mL Stem Not determined [75] Br. P. aeruginosa (M) 1250 μg/mL E. coli (M) 310 μg/mL Schkuhria pinnata (Lam.) Shoots Not determined [75] P. aeruginosa (M) 1250 μg/mL (M) 505 μg/mL; (W) 312 μg/mL; (E) Non-toxic in Artemia Schotia bractopetalia Sond. Leaves E. coli [71] 491 μg/mL; (A) 312 μg/mL lethality assay (M) 156 μg/mL; (W) 312 μg/mL; (E) Spirostachys africana Sond. Stem bark E. coli Not determined [82] 156 μg/mL; (A) 156 μg/mL E. coli (M) 499 μg/mL; (W) 790 μg/mL [71] (M) 312 and 387 μg/mL (bark and leaves respectively); (W) 387 and K. pneumoniae [41] 335 μg/mL (bark and leaves respectively) (M) 969 and 474 μg/mL (bark and Syzygium cordatum Leaves Non-toxic in Artemia leaves respectively); (W) 932 and (Hochst.) and bark P. mirabilis lethality assay [40] 49 μg/mL (bark and leaves respectively) (M) 751 and 641 μg/mL (bark and leaves respectively); (W) 1325 and P. vulgaris [40] 658 μg/mL (bark and leaves respectively) Strychnos madagascariensis Non-toxic in Artemia Leaves E. coli (M) 580 μg/mL; (W) 593 μg/mL [71] Poir. lethality assay E. coli (A) 40 μg/mL Strychnos mitis S.Moore Not stated Not determined [76] P. aeruginosa (A) 160 μg/mL Sutherlandia frutescens (L.) Not toxic in human Leaves E. coli (W) > 8000 μg/mL [73] R.Br. epithelial kidney cells Terminalia phanerophlebia E. coli (A) 80 μg/mL Not stated Not determined [79] Engl. & Diels, P. aeruginosa (A) 80 μg/mL E. coli (M) 278 μg/mL; (W) 624 μg/mL [71] Terminalia pruinoides M.A. K. pneumoniae (M) 432 μg/mL; (W) 531 μg/mL Non-toxic in Artemia [41] Leaves Lawson P. mirabilis (M) 313 μg/mL; (W) 224 μg/mL lethality assay [40] P. vulgaris (M) 926 μg/mL; (W) 379 μg/mL Terminalia sambesiacia E. coli (A) 60 μg/mL Not stated Not determined [79] Engl. & Diels. P. aeruginosa (A) 60 μg/mL
14 Evidence-Based Complementary and Alternative Medicine Table 2: Continued. Plant part Pathogens Plant species MIC values Toxicity evaluation References used screened E. coli (M) 396 μg/mL; (W) 276 μg/mL [71] Terminalia sericea Burch. ex K. pneumoniae (M) 254 μg/mL; (W) 318 μg/mL Non-toxic in Artemia [41] Leaves DC. P. mirabilis (M) 417 μg/mL; (W) 103 μg/mL lethality assay [40] P. vulgaris (M) 508 μg/mL; (W) 520 μg/mL (M) 1000 μg/mL; (W) > 8000 μg/mL; E. coli (D) 8000 μg/mL Non-toxic in Artemia Trichilia dregeana Sond. Leaves [80] (M) 1500 μg/mL; (W) > 8000 μg/mL; lethality assay E. faecalis (D) 4000 μg/mL (M) 1000 μg/mL; (W) > 8000 μg/mL; Non-toxic in Artemia Trichilia emetica Vahl. Leaves E. coli [80, 84] (D) 8000 μg/mL lethality assay Roots: (M) 387 μg/mL; Leaves: (M) E. coli [71] 30 μg/mL LC50 � 772 μg/mL in Tulbaghia violaceae Harv. Leaves K. pneumoniae Roots; (M) 526 μg/mL; (W) 613 μg/mL Artemia lethality assay [41] P. mirabilis Leaves: (W) 125 μg/mL [40] (M) 4000 μg/mL; (W) > 8000 μg/mL; Non-toxic in Artemia Turraea floribunda Hochst. Leaves E. coli [80] (D) 4000 μg/mL lethality assay (M) 2000 μg/mL; (W) > 8000 μg/mL; Non-toxic in Artemia Turraea obtusifolia Hochst. Leaves E. coli [80] (D) 8000 μg/mL lethality assay E. coli (A) 600 μg/mL Vepris reflexa I. Verd. Not stated Not determined [79] P. aeruginosa (A) 1250 μg/mL Leaves: (M) 239 μg/mL; (W) 304 μg/ E. coli [71] mL (M) 624 μg/mL (bark); (W) 677 μg/mL K. pneumoniae [41] (bark) Warburgia salutaris Leaves (M) 623 and 465 μg/mL (bark and Non-toxic in Artemia (Bertol.f.) Chiov. and bark P. mirabilis leaves respectively); (W) 417 μg/mL lethality assay [40] (bark) (M) 450 and 688 μg/mL (bark and P. vulgaris leaves respectively); (W) 1203 μg/mL [40] (leaves) (M) 156 μg/mL; (W) 312 μg/mL; (E) Ximenia caffra Sond. Stem bark E. coli Not determined [82] 312 μg/mL; (A) 312 μg/mL Zanthoxylem capensis E. coli (A) 310 μg/mL Not stated Not determined [76] (Thunb.) Harv. P. aeruginosa (A) 310 μg/mL E. coli (M) 2500 μg/mL Ziziphus murconata Willd. Bark Not determined [75] P. aeruginosa (M) 1250 μg/mL representation, with nineteen species reported as treatments study were cited by multiple sources as traditional UTI for UTIs (Figure 1). Leguminosae were also commonly used therapies, indicating that screening and validation of those as UTI therapies, with fourteen plant species reported species should be prioritised. [42, 43]. Asparagaceae, Rutaceae, and Lamiaceae were also The main plant parts used to prepare therapies to treat well represented, with eight, six, and six species used to treat UTIs are leaves (27%), followed by roots, bulbs, and rhi- UTIs, respectively. Five species each of Amaryllidaceae, zomes (22%) (Figure 2). For 48 plant species (31%), the Solanaceae, and Malvaceae, as well as four species of both specific plant part used was not specified in the cited lit- Euphorbiaceae and Poaceae, and three species of Ger- erature. For Solanum capense L. and Pelargonium ramo- aniaceae and Xanthorrhoeaceae were also used for this sissimum Willd., both leaves and stems were used to treat purpose. A further twenty-four plant families were repre- UTIs, so both parts are recorded in Table 1 for that purpose sented by two or fewer individual species. Of these, Apto- [43, 58]. Fruits were found to be the least used parts as they simum procumbens (Lehm.) Burch. ex Steud, Arctopus are only available for short periods seasonally and may not echinatus L., Boophone disticha (L.f.) Herb., Bowiea volubilis be always readily available. Harv., Cardiospermum halicacabum L., Cissampelos capensis L.f., Galenia africana L., Helichrysum odoratissimum (L.) Sweet, and Zantedeschia albomaculata (Hook.) Baill have 3.2. Dosage and Toxicity. Long term use of medicinal plants been cited by several sources that also experimentally val- to treat diseases has resulted in the assumption that me- idated their use for the treatment of UTIs [47, 62, 64]. dicinal plants are nontoxic and safe for therapeutic use [39]. Approximately 47% of the plant species identified in our Of the plants specified for traditional use for UTIs (Table 1),
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