Recent Advances in Anti-Infective Drug Discovery - Volume 20, Issue 3, 2025

Tinea infections are superficial fungal infections caused by three species of fungi (i.e. Epidermophyton, Microsporum, and Trichophyton) collectively termed dermatophytes. Dermatophytes are fungi that cause skin, nail bed, and hair infections. These infections are classified based on infection site, including tinea pedis (foot), tinea corporis (body), tinea capitis (head), and tinea cruris (groin). Dermatophytes can spread by direct contact with other people (anthropophilic organisms), animals (zoophilic organisms), and soil (geophilic organisms), as well as indirectly from fomities.

This review aims to summarize the allopathic drugs along with their mechanism of action and herbal drugs including their parts of the plant used for the treatment of tinea infections.

The literature review was performed using the following databases: PubMed (https://pubmed.ncbi.nlm.nih.gov/), and Google Scholar (https://scholar.google.com/), to identify the various drugs involved in the treatment of dermatophytosis along with their mechanisms.

The following keywords were applied in the search strategy: “Tinea”, “Dermatophytosis”, “Ringworm infection”, “Pathogenesis of tinea”, “Tinea pedis”, and “Tinea capitis”. This article also reviews several formulations that are available in the market for treating ringworm infection.

The current review provides information about the classification of dermatophytosis based on infection site and environmental habitat, pathogenesis, immunopathogenesis of dermatophytes, and herbals and allopathic drugs used for their treatment.

Antimicrobial Resistance (AMR) has emerged as a critical global health challenge, with bacteria, viruses, fungi, and parasites developing the capacity to survive antimicrobial treatments. This resistance, largely driven by increased antibiotic usage, threatens public health by diminishing the effectiveness of current infection management strategies.

This study aims to evaluate the antimicrobial resistance patterns of prevalent pathogens in a secondary care hospital, highlighting the essential role of clinical pharmacists in addressing AMR through the implementation of Antibiotic Stewardship Programs (ASPs) to promote responsible antibiotic use.

This prospective study analyzed 80 positive microbial culture reports from six months. Ethical approval was granted by the Institutional Ethical Committee (Ref: ECR/288/Indt/TN/2018/RR-21/001, dated April 6, 2023). Inclusion criteria covered adults (≥18 years) with confirmed infections across various sites, including bloodstream, urinary, respiratory, and soft tissue. Exclusion criteria eliminated reports with no pathogen growth. Data were analyzed using SPSS software version 26.0, with statistical measures applied to assess resistance patterns and correlations across infection types.

Of the 80 positive cultures, Escherichia coli 35.0%) was most frequently isolated, followed by Klebsiella pneumoniae (12.5%), Pseudomonas aeruginosa (8.8%), Proteus mirabilis (8.8%), and Klebsiella oxytoca (7.5%). The isolated pathogens displayed high resistance to ampicillin (82.5%), cefixime (80.0%), ceftriaxone (78.8%), and ceftazidime (71.3%), with a strong sensitivity to amikacin (86.3%) and meropenem (70.0%).

The rise of third-generation cephalosporin-resistant pathogens signals an urgent need for sustained AMR monitoring and robust ASPs in healthcare settings, particularly in developing regions. The study underscores the importance of rational antibiotic use and continuous AMR surveillance to curb resistant infections and protect public health.

Pseudomonas aeruginosa is a common cause of healthcare-associated infections such as Pneumonia, Bloodstream, Urinary tract, and Surgical site infections this bacterium is also reported to cause infections in cancerous cells. It is one of the most considered opportunistic human pathogens, especially in immunocompromised patients, and one of the top five pathogens of nosocomial diseases worldwide. Some P. aeruginosa are becoming more resistant to even antibiotics of last resort, including beta-lactams, fluoroquinolones, tetracycline, chloramphenicol, macrolides, and aminoglycosides, and are described as multidrug-resistant. Multiple lines of evidence suggest that the chief mechanism for P. aeruginosa is resistance to antibiotics regulated by the efflux pumps. Antibiotic efflux pumps are membrane proteins that actively remove antibiotics from the bacterial cell, lowering on-target antibiotic concentrations to sub-toxic levels. The MexAB-OprM system is one of the largest multi-drug resistant clinically relevant efflux pumps with high expression levels in P. aeruginosa. Inhibition of these MDR efflux pumps can restore the activity of antimicrobial agents that are substrates for this protein. We performed molecular modelling studies in this study to discover novel Mex B efflux pump inhibitors. We evaluated the MIC of α-Bisabolol and Meropenem combination against Meropenem-resistant Pseudomonas Aeruginosa strains. This research opened up the possibility of using this plant compound α-Bisabolol and resistance drug Meropenem combination in the development of medicines for human consumption, possibly for the treatment of Hospital-Acquired Pneumonia, and multidrug-resisting infection caused by P. Aeruginosa including wound and urinary infections which have been reported important HAI carbapenem class multidrug infections caused by the bacteria.

The present study investigates the interactions of plant secondary metabolites tables on Mex B efflux protein. It identifies lead molecules for developing adjuvants against efflux-mediated multidrug resistance in P. aeruginosa infections, enhances antibiotic activity against MDR pathogens, and evaluates the MIC value of the test plant compound (Bisabolol) and the resistant antibiotic (Meropenem).

Among plant compounds, α-Bisabolol, myricetin, capsaicin, equenin, aloe-emodin, terpinene, fisetin, taxifolin, catechin, and galangin showed G-Scorehigher than -7 kcal/mol, and interact with active amino acids Mex B efflux protein which may affect the efflux transport of drug and enhance the antibiotic activity against MDR infection. According to docking experiments, α-bisabolol has a higher affinity energy to the MexB protein than Meropenem. Furthermore, α-bisabolol binds to the MexB binding site hydrophobic trap region of MexB, which may cause a conformational change in the transporter's pumping process, thereby affecting antibiotic efflux inhibition. The MICs against Meropenem Pseudomonas Aeruginosa were 12.5 µg/ml for antibiotic Meropenem and 6.24 μg/ml for the combination.

The study concluded that these plant secondary metabolite compounds could be used to develop adjuvant along with antibiotics to increase their activity against MexAB-OprM efflux-mediated multidrug-resisting infections. It was determined that α-bisabolol may have the potential to boost antibacterial activity when combined with antibiotics, as well as being a strong candidate for an efflux pump inhibitor. This is the first inclusion of the properties of a natural plant phytochemical, Bisabolol, utilized in combination with commercial resistant antibiotic Meropenem to enhance its activity against MDR pneumonia infection caused by Pseudomonas Aeruginosa.