Palabras clave
farmacocinética
antiinfecciosos
plantas medicinales
farmacorresistencia microbiana
Cómo citar
Resumen
Este artículo analiza la resistencia a los antimicrobianos como un problema de salud pública global y examina las interacciones entre plantas medicinales y medicamentos antimicrobianos. El motivo del estudio radica en el uso extendido de plantas medicinales en Costa Rica como complemento terapéutico, lo que incrementa la probabilidad de interacciones capaces de modificar la eficacia de los tratamientos y contribuir al desarrollo de resistencia. El objetivo fue revisar la evidencia sobre interacciones farmacocinéticas y farmacodinámicas entre plantas medicinales de uso frecuente en la población costarricense y los antimicrobianos orales incluidos en la Lista Oficial de Medicamentos de la Caja Costarricense de Seguro Social. Se realizó una revisión bibliográfica narrativa en MEDLINE vía PubMed, Scopus y Web of Science, priorizando estudios sobre metabolismo de fármacos relacionados con enzimas del citocromo P450, transportadores como la glicoproteína P e interacciones farmacodinámicas. Los resultados muestran que numerosos antibióticos y antiparasitarios son sustratos de estos sistemas que pueden ser modulados por plantas medicinales, generando cambios en la concentración plasmática y la eficacia terapéutica. Además, se identificaron interacciones farmacodinámicas predominantemente sinérgicas, en las que compuestos vegetales potencian la actividad antimicrobiana mediante alteración de membranas celulares, aumento de la permeabilidad bacteriana o acción sobre múltiples blancos del patógeno. También se documentaron casos de antagonismo in vitro en combinaciones específicas con algunos antimicrobianos. En conclusión, estas interacciones son relevantes para la práctica clínica y respaldan la necesidad de fortalecer la investigación clínica y la farmacovigilancia para promover el uso seguro y racional de plantas medicinales y antimicrobianos.
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