Keywords
pharmacokinetics
anti-infective agents
medicinal plants
drug resistance microbial
How to Cite
Abstract
This paper examines antimicrobial resistance as a global public health challenge and explores interactions between medicinal plants and antimicrobial drugs. This study was motivated by the widespread use of medicinal plants as complementary therapies in Costa Rica, which may increase the risk of interactions that alter treatment efficacy and contributing to the development of antimicrobial resistance. The objective was to review the evidence on pharmacokinetic and pharmacodynamic interactions between medicinal plants commonly used in Costa Rican and oral antimicrobial agents included in the Official Drug List of the Costa Rican Social Security Fund (CCSS). A narrative literature review was conducted using MEDLINE via PubMed, Scopus, and Web of Science, with a focus on studies addressing drug metabolism mediated by cytochrome P450 enzymes, drug transporters such as P-glycoprotein, and pharmacodynamic interactions. The results indicate that numerous antibiotics and antiparasitic agents are substrates of these systems, the activity of which may be modulated by medicinal plants, leading to changes in plasma drug concentrations and therapeutic efficacy. Predominantly synergistic pharmacodynamic interactions were also identified, in which plant-derived compounds enhance antimicrobial activity by disrupting cell membranes, increasing bacterial permeability, or acting on multiple pathogen targets. In addition, cases of in vitro antagonism were reported for specific combinations with certain antimicrobial agents. In conclusion, these findings have important implications for clinical practice and highlight the need to strengthen clinical research and pharmacovigilance to promote the safe and rational use of medicinal plants and antimicrobial agents.
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