Comparative Susceptibility of Staphylococcus aureus and S. pyogenes to Musa paradisiaca Linn Leaf Extract and Fusidic Acid in Impetigo Patients
Main Article Content
Introduction. An estimated 12% of the world’s population is at risk of experiencing impetigo. The prevalence of impetigo in developing countries ranges from 111 to 140 million cases. Impetigo often occurs in children aged 2-5 years. One way to overcome this condition involves using natural products or phytochemicals that are effective, safe, and economical. One of the Indonesian plants that can be used as an alternative medicine with antibacterial effects is the kepok banana leaves (Musa paradisiaca Linn). This study aimed to assess the susceptibility of S. aureus and S. pyogenes to the antimicrobial potential of the extract of M. paradisiaca leaf extract and fusidic acid using isolates from impetigo patients. Methods. This in vitro experimental study used a post-test-only control-group design. Bacterial isolates were obtained from impetigo patients and tested using the disk diffusion method following CLSI standards. Group comparisons were conducted using the Kruskal–Wallis test followed by Mann–Whitney U tests. A p-value < 0.05 was considered statistically significant. Results. Bivariate analysis showed a significant difference in the susceptibility of S. aureus between fusidic acid and M. paradisiaca extract (p < 0.05), where fusidic acid demonstrated larger inhibition zones. Similarly, a significant difference was observed for S. pyogenes (p < 0.05). However, there was no significant difference between the 50% and 100% extract concentrations. Conclusion. M. paradisiaca leaf extract exhibits antibacterial activity against S. aureus and S. pyogenes, but is significantly less effective than standard fusidic acid treatment in vitro.
Keywords:
Impetigo
Musa paradisiaca linn leaf extract
S. pyogenes
Staphylococcus aureus
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36. Santy DFM, Fadillah Q, Hasan RSB, Lina J. The Antibacterial Potential of Ethanol Extract from Banana Peel (M. paradisiaca) On The Growth of S. aureus and Streptococcus pneumoniae. Riwayat: Educational Journal of History and Humanities. 2023;6(3).
2. Lior Z, Lior C, Gideon C. Current Microbiological, Clinical and Therapeutic Aspects of Impetigo. Clin Med Rev Case Rep. 2018;5(2):205.
3. Wardhani I. Repositori Institusi Universitas Sumatera Utara. Gambaran Karakteristik Impetigo di RSUP Haji Adam Malik Medan Periode 2013-2015. Repositori Institusi Universitas Sumatera Utara. [internet]. 2017. [Citated 12 Mei 2023].
4. Depari LI, Sugiri U, Ilona L. Relation Between Risk Factors of Pyoderma and Pyoderma Incidence. Althea Med J. 2016;3(3):434-39.
5. Siswati AS, Rosita C, Triwahyudi D, Budianti WK, Mawardi P, Dwiyana RF, editor. Panduan Praktik Klinis Bagi Dokter Spesialis Dermatologi dan Venereologi Indonesia. Jakarta Pusat: Perhimpunan Dokter Spesialis Kulit dan Kelamin Indonesia (PERDOSKI); 2021. p. 102-6.
6. Velappan R, Ramasamy S, Venu S, Chandrasekar M. A Randomized Open Label Comparative Study Evaluating The Effectiveness, Adherence And Safety Between 2% Mupirocin Ointment and 2% Fusidic acid Cream In Children With Impetigo. Int J Res Dermatol. 2019;5(3):511-6.
7. Ce R, Pacheco BZ, Ciocheta TM, Barbosa FS, Alves ACS, Dallemole DR, et al. Antibacterial Activity Against Gram-Positive Bacteria Using Fusidic acid-Loaded Lipid-Core Nanocapsules. React Funct Polym. 2021;162:1-13.
8. Galindo E, Hebert AA. A Comparative Review of Current Topical Antibiotics For Impetigo. Expert Opin Drug Saf. 2021;20(6):677-83.
9. Nassar MSM, Hazzah WA, Bakr WMK. Evaluation of Antibiotic Susceptibility Test Result: How Guilty A Laboratory Could Be. J Egypt Public Health Assoc. 2019;94(4):1-5.
10. Ningsih AP, Agustien A, Nurmiati. Uji Aktivitas Antibakteri Ekstrak Kental Tanaman Pisang Kepok Kuning (M. paradisiaca.) Terhadap S. aureus dan Escherichia coli.J Bio UA. 2013;2(3):207-13.
11. Departemen Kesehatan Republik Indonesia. Kebijakan Obat Tradisional Nasional Tahun 2007. Departemen Kesehatan Republik Indonesia [internet]. 2003 [citated 30 October 2023].
12. Owusu-Boadi E, Akuoko Essuman M, Mensah G, Ayamba Ayimbissa E, Boye A. Antimicrobial Activity Against Oral Pathogens Confirms The Use Of M. paradisiaca Fruit Stalk In Ethnodentistry. Evidence-Based Complementary and Alternative Medicine. 2021;2021:1–9.
13. Karuppiah P, Mustaffa M. Antibacterial and Antioxidant Activities Of Musa Sp. Leaf Extracts Against Multidrug Resistant Clinical Pathogens Causing Nosocomial Infection. Asian Pac J Trop Biomed. 2013;3(9):737–42. doi: 10.1016/S2221-1691(13)60148-3
14. Mariani, R., Noviyanti, N., Inayah, R., & Wibowo, D. P. Review: Antioxidant Activity of Indonesian Banana Peels . Jurnal Ners. 2025;9(4):7729–34.
15. Budiani LD, Adiguna MS. Penatalaksanaan pioderma terkini. Med Dermatol Venerol. 2014;41(2):85-90.
16. Hazarika N. A Clinico-Epidemiological Study of Pyoderma in Children. Nat J Res Com Med 2012;1(4):178 -241.
17. Biro Pusat Statistik. Penggolongan Pendapatan Penduduk. Jakarta: Biro Pusat Statistik; 2014.
18. Loadsman MEN, Verheij TJM, Velden AWVD. Impetigo Incidence and Treatment: A Retrospective Study of Dutch Routine Primary Care Data. Fam Pract. 2019:410-16.
19. Romani L, Whitfeld MJ, Koroivueta J, Kama M, Wand H, Tikoduadua L, et al. The Epidemiology of Scabies and Impetigo in Relation to Demographic and Residential Characteristic: Baseline Findings From The Skin Health Intervention Fiji Trial. Am J Trop Med Hyg. 2017;97(3):845-50.
20. Pereira LB. Impetigo-Review. An Bras Dermatol. 2014;89(2):293-9.
21. Rainer LA, Molefi TL, Kololo SO, Leeme TB, Selemogo M, Molefi M. Prevalence And Associated Risk Factors Of Scabies And Impetigo: A Cross-Sectional Study In Tutume District, Botswana. PLoS Negl Trop Dis. 2024;18(6):e0011495.
22. Pangow CC, Pandaleke HE, Kapantow GM. Profil Pioderma Pada Anak Di Poliklinik Kulit Dan Kelamin RSUP Prof. Dr. R. D. Kandou Manado Periode Januari-Desember 2012. e-Clinic Journal. 2015;3(1): 526-30. Doi: https://doi.org/10.35790/ecl.v3i1.6820.
23. Lacey JA, Marcato AJ, Chisholm RH, Campbell PT, Zacherson C, Price DJ, et al. Evaluating The Role Of Asymptomatic Throat Carriage Of S. pyogenes In Impetigo Transmission In Remote Aboriginal Communities In Northern Territory, Australia: A Retrospective Genomic Analysis. Lancet Microbe. 2023;4(1):e524-33.
24. Bowen AC, Mahe A, Hay RJ, Andrews RM, Steer AC, Tong SY, et al. The Global Epidemiology Of Impetigo: A Systematic Review Of The Population Prevalence Of Impetigo And Pyoderma. PLoS One. 2015;10(8):1-15.
25. Ramadhani P, Erly, Asterina. Hambat Ekstrak Etanol Rimpang Kunyit Terhadap Pertumbuhan Bakteri Secara In Vitro. Jurnal Kesehatan Andalas 2017;6(30):1-5.
26. Pratama HD, Ernawati, Mahmud NRA. Uji Antibakteri Ekstrak Kulit Buah Pisang Kepok (M. paradisiaca X Balbisiana) Mentah Terhadap Pertumbuhan Bakteri S. aureus. Sainsmat.2018;7(2): 147-52.
27. Rankin ID. MIC Testing. Dalam: Coyle MB, penyunting. Manual of Antimicrobial Susceptibility Testing. Edisi ke-1. Seattle;2005. p.53-62.
28. Zhao H, Wang X, Wang B, Xu Y, Rao L, Wan B, et al. The Prevalence and Determinants of Fusidic acid Resistance Among Methicillin-Resistant S. aureus Clinical Isolates in China. Front Med (Lausanne). 2021 Nov 30;8:761894.
29. Katalog Badan Pusat Statistik. Ringkasan Statistik Pendidikan Indonesia 2016. Jakarta: Katalog Badan Pusat Statistik [Internet].2016 [citated 30 October 2023].
30. Kapadia S, Pudakalkatti P, Shivanaikar S. Detection Of Antimicrobial Activity Of Banana Peel (M. paradisiaca L.) On Porphyromonas gingivalis And Aggregatibacter Actinomycetemcomitans: An In Vitro Study. Contemp Clin Dent. 2015;6(4):496.
31. Sarwade PP, Gaisamudre KN, Sonwani K, Chand S, Goswami M, Kaur H, et al. M. paradisiaca It's Phytochemistry, Traditional Uses And Pharmacological Activities. As J Phar Develop. 2025;13(6):273–85.
32. Mustofa HS. Banana Plant As A Source Of Valuable Antimicrobial Compounds And Its Current Applications In The Food Sector. J Food Scien. 2021;86(9):3778–97.
33. Velthuis F, Nauta IM, Altorf-van der Kuil W, Notermans DW, Zwittink RD, Schoffelen AF, et al. Increasing Trend In Fusidic acid Resistance Among MRSA Isolates In The Netherlands, 2016–23. JAC Antimicrob Resist. 2025;7(6).
34. Zhao H, Wang X, Wang B, Xu Y, Rao L, Wan B, et al. The Prevalence and Determinants of Fusidic acid Resistance Among Methicillin-Resistant S. aureus Clinical Isolates in China. Front Med (Lausanne). 2021;8.
35. Boloki HA, Al-Musaileem WF, AlFouzan W, Verghese T, Udo EE. Fusidic acid Resistance Determinants in Methicillin-Resistant S. aureus Isolated in Kuwait Hospitals. Medical Principles and Practice. 2021;30(6):542–9.
36. Santy DFM, Fadillah Q, Hasan RSB, Lina J. The Antibacterial Potential of Ethanol Extract from Banana Peel (M. paradisiaca) On The Growth of S. aureus and Streptococcus pneumoniae. Riwayat: Educational Journal of History and Humanities. 2023;6(3).
