Determining the antibacterial efficacy of Amoxicillin-Clavulanic acid (Augmentin®), Metronidazole and Ethanolic extract of Moringa oleifera L. against clinically isolated Porphyromonas gingivalis (in vitro study)
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Abstract
Background: Amoxicillin-clavulanic acid (Augmentin®), Metronidazole, Amoxil/Metro combination, and Azithromycin are commonly utilized as adjunctive treatment of periodontitis. Moringa oleifera L (Mo) leaves extracts have demonstrated the ability to inhibit the growth of facultative anaerobic bacteria including Porphyromonas. gingivalis (P. gingivalis), Escherichia coli, Pseudomonas aeruginosa, Bacillus cereus, Shigella sonnei, Staphylococcus aureus, Bacillus subtilis, Beta-hemolytic streptococcus, Bacillus megaterium as well as dental biofilm development. Objectives: The present study was set out to determine the antibacterial efficacy of Amoxicillin-clavulanic acid (Augmentin®), Metronidazole and Ethanolic extract of Mo leaves against P. gingivalis clinical isolate. Materials and Methods: The minimum inhibition concentrations (MIC), minimum bactericidal concentrations (MBC), and sensitivity of the clinical isolated P. gingivalis against Mo ethanolic leaves extracts, Augmentin, and Metronidazole were determined using two-fold serial dilution, agar well diffusion, and disk diffusion, respectively. The gas chromatography–mass spectrometry (GC-MS) was used for phytochemical analysis of the Mo leaves extract using ethanol solvent. Results: P. gingivalis exhibited inhibition to Mo leaves extract, while it demonstrated resistance to Augmentin and Metronidazole. MIC and MBC of Mo leaves extract were found to be 0.78 mg/ml and 1.56 mg/ml against P. gingivalis, respectively. The extract had highest anti-biofilm effect at the minimum concentrations of 1.55 mg/ml and 0.78 mg/ml equivalent to 0.06% Chlorhexidine compared to its lowest conc at 0.34 mg/ml, and this activity was inversely proportional to the extract’s concentration. Conclusion: While Augmentin and Metronidazole showed no sensitivity against P. gingivalis, the promising antibacterial effect of Mo leaves extract against this bacterium may indicates its potential for use in oral health promotion, suggesting further in vivo studies to validate Mo extracts as alternative adjuncts in periodontitis therapy.
Received date: 04-10-2025
Accepted date: 05-11-2025
Published date: 15-12-2025
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References
Hajishengallis G, Lamont RJ. Breaking bad: Manipulation of the host response by Porphyromonas gingivalis. Eur J Immunol. 2014;44(2):328-38.
Hajishengallis G, Lambris JD. Microbial manipulation of receptor crosstalk in innate immunity. Nat Rev Immunol. 2011;11(3):187-200.
Zhou Q, Leeman SE, Amar S. Signaling mechanisms in the restoration of impaired immune function due to diet-induced obesity. Proc Natl Acad Sci U S A. 2011; 108(7):2867-72.
Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Beglundh T, et al. EFP Workshop Participants and Methodological Consultants. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020; 47 Suppl 22:4-60.
Herrera D, van Winkelhoff AJ, Matesanz P, Lauwens K, Teughels W. Europe's contribution to the evaluation of the use of systemic antimicrobials in the treatment of periodontitis. Periodontol 2000. 2023; 00: 1-28.
Walker CB. The acquisition of antibiotic resistance in the periodontal microflora. Periodontol 2000. 1996; 10:79-88.
Feres M, Retamal-Valdes B, Fermiano D, Faveri M, Figueiredo LC, Mayer MP, et al. Microbiome changes in young periodontitis patients treated with adjunctive metronidazole and amoxicillin. J Periodontol. 2021;92(4):467-78.
Thomas RE, Sautter JD, van Winkelhoff AJ. Emergence of Antibiotic-Resistant Porphyromonas gingivalis in United States Periodontitis Patients. Antibiotics 2023;12(11):1584.
Mitea G, Schröder V, Iancu IM. Bioactive Plant-Derived Compounds as Novel Perspectives in Oral Cancer Alternative Therapy. Pharmaceuticals. 2025;18(8):1098.
Luepke KH, Suda KJ, Boucher H, Russo RL, Bonney MW, Hunt TD, et al 3rd. Past, Present, and Future of Antibacterial Economics: Increasing Bacterial Resistance, Limited Antibiotic Pipeline, and Societal Implications. Pharmacotherapy. 2017;37(1):71-84.
Jwa SK. Efficacy of Moringa oleifera Leaf Extracts against Cariogenic Biofilm. Prev Nutr Food Sci. 2019;24(3):308-12.
Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018; 89 Suppl 1:S173-S182.
Faisal Madhloom A, Bashir Hashim Al-Taweel F, Sha A, Raad Abdulbaqi H. Antimicrobial Effect of Moringa Oleifera L. and Red Pomegranate against Clinically Isolated Porphyromonas gingivalis: in vitro Study. Arch Razi Inst. 2022;77(4):1405-1419.
Gebhardt N. Fluorescence in Situ Hybridization (fish): Application Guide. Berlin: Springer; 2010.
Sakamoto M, Takeuchi Y, Umeda M, Ishikawa I, Benno Y. Rapid detection and quantification of five periodontopathic bacteria by real‐time PCR. Microbiol Immunol. 2001;45(1):39-44.
Seidel V. Initial and bulk extraction of natural products isolation. In: Sarker SD, Nahar L, editors. Natural Products Isolation. New York: Humana Press; 2012. p. 27-41.
Lorenzo M, Pico Y. Gas chromatography and mass spectroscopy techniques for the detection of chemical contaminants and residues in foods. In Chemical contaminants and residues in food. 2017; 15-50.
Elleuch L, Shaaban M, Smaoui S, Mellouli L, Karray-Rebai I, Fourati-Ben Fguira L, et al. Bioactive secondary metabolites from a new terrestrial Streptomyces sp. TN262. Appl Biochem Biotechnol. 2010;162(2):579-93.
Akinduti PA, Emoh-Robinson V, Obamoh-Triumphant HF, Obafemi YD, Banjo TT. Antibacterial activities of plant leaf extracts against multi-antibiotic resistant Staphylococcus aureus associated with skin and soft tissue infections. BMC Complement Med Ther. 2022;22(1):47.
Kimaro E, Yusto E, Mohamed A, Silago V, Damiano P, Hamasaki K, et al. Quality equivalence and in-vitro antibiotic activity test of different brands of amoxicillin/clavulanic acid tablets in Mwanza, Tanzania: A cross sectional study. Heliyon. 2023;10(1):e23418.
Matuschek E, Copsey-Mawer S, Petersson S, Åhman J, Morris TE, Kahlmeter G. The European committee on antimicrobial susceptibility testing disc diffusion susceptibility testing method for frequently isolated anaerobic bacteria. Clin Microbiol Infect. 2023;29(6):795.e1-795.e7.
Saquib SA, AlQahtani NA, Ahmad I, Kader MA, Al Shahrani SS, Asiri EA. Evaluation and Comparison of Antibacterial Efficacy of Herbal Extracts in Combination with Antibiotics on Periodontal pathobionts: An in vitro Microbiological Study. Antibiotics (Basel). 2019; 8(3): 89.
Wunsch CM, Lewis JP. Porphyromonas gingivalis as a model organism for assessing interaction of anaerobic Bacteria with host cells. J Vis Exp. 2015(106):e53408.
Cavalieri S, Harbeck R, McCarter Y, Ortez J, Rankin I, Sautter R, et al. Manual of antimicrobial susceptibility testing. Washington, DC: American Society for Microbiology; 2005.
Mathur T, Singhal S, Khan S, Upadhyay D, Fatma T, Rattan A. Detection of biofilm formation among the clinical isolates of staphylococci: an evaluation of three different screening methods. Indian J Med Microbiol. 2006;24(1):25-9.
Teles RP, Haffajee AD, Socransky SS. Microbiological goals of periodontal therapy. Periodontol 2000. 2006;42(1):180-218.
Jervøe-Storm PM, Alahdab H, Koltzscher M, Fimmers R, Jepsen S. Comparison of curet and paper point sampling of subgingival bacteria as analyzed by real-time polymerase chain reaction. J Periodontol. 2007 ;78(5):909-17.
Belibasakis GN, Schmidlin PR, Sahrmann P. Molecular microbiological evaluation of subgingival biofilm sampling by paper point and curette. APMIS. 2014 Apr;122(4):347-52.
Lee JE, Jayakody JTM, Kim JI, Jeong JW, Choi KM, Kim TS, et al. The Influence of Solvent Choice on the Extraction of Bioactive Compounds from Asteraceae: A Comparative Review. Foods. 2024;13(19):3151.
Liga S, Magyari-Pavel IZ, Avram Ș, Minda DI, Vlase AM, Muntean D, et al. Comparative Analysis of Moringa oleifera Lam. Leaves Ethanolic Extracts: Effects of Extraction Methods on Phytochemicals, Antioxidant, Antimicrobial, and In Ovo Profile. Plants (Basel). 2025;14(11):1653.
Balouiri M, Sadiki M, Ibnsouda SK. Methods for in vitro evaluating antimicrobial activity: A review. J Pharm Anal. 2016;6(2):71-79.
Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing, 28th ed.; CLSI Supplement M100; Clinical and Laboratory Standards Institute: Wayne, PA, USA, 2018; ISBN1 978-1-68440-066-9. [Print]; ISBN2 978-1-68440-067-6.
Naqid IA, Balatay AA, Hussein NR, Ahmed HA, Saeed KA, Abdi SA. Bacterial strains and antimicrobial susceptibility patterns in male urinary tract infections in Duhok province, Iraq. Middle East J Rehabil Health Stud. 2020;7(3):e103529.
Al-Deen HS, Al-Ankoshy AAM, Al-Najhi M, Al-Kabsia T, AL-Haddad KA, Al-Akwa AAY, et al. Porphyromonas gingivalis: Biofilm formation, antimicrobial susceptibility of isolates from cases of Localized Aggressive Periodontitis (LAP). Univers J Pharm Res. 2021;6(4):1-7.
Olsen I, Chen T, Tribble GD Genetic exchange and reassignment in Porphyromonas gingivalis. Journal of Oral Microbiology. 2018; 10(1).
Attallah NGM, Negm WA, Elekhnawy E, Altwaijry N, Elmongy EI, El-Masry TA, et al. Antibacterial Activity of Boswellia sacra Flueck. Oleoresin Extract against Porphyromonas gingivalis Periodontal Pathogen. Antibiotics (Basel). 2021;10(7):859.
Fischer CL, Walters KS, Drake DR, Dawson DV, Blanchette DR, Brogden KA, et al. Oral mucosal lipids are antibacterial against Porphyromonas gingivalis, induce ultrastructural damage, and alter bacterial lipid and protein compositions. Int J Oral Sci. 2013;5(3):130-40.
Eltigani SA, Eltayeb MM, Ishihara A, Arima J. Isolates from Monechma ciliatum seeds' extract hampered Porphyromonas gingivalis hemagglutinins. J Food Biochem. 2019;43(11):e13029.
Lynch AS, Robertson GT. Bacterial and fungal biofilm infections. Annu Rev Med. 2008;59:415-28.