Review Article A Review of Plant-Based Therapies for the Treatment of Urinary Tract Infections in Traditional Southern African Medicine
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Hindawi
Evidence-Based Complementary and Alternative Medicine
Volume 2021, Article ID 7341124, 20 pages
https://doi.org/10.1155/2021/7341124
Review Article
A Review of Plant-Based Therapies for the Treatment of Urinary
Tract Infections in Traditional Southern African Medicine
Ian Cock ,1,2 Nothando Mavuso,3 and Sandy Van Vuuren 3
1
School of Environment and Science, Griffith University, Brisbane 4111, Australia
2
Environmental Futures Research Institute, Griffith University, Brisbane, Australia
3
Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
Gauteng 2193, South Africa
Correspondence should be addressed to Sandy Van Vuuren; sandy.vanvuuren@wits.ac.za
Received 30 April 2021; Accepted 9 July 2021; Published 30 July 2021
Academic Editor: Olufunmiso Olusola Olajuyigbe
Copyright © 2021 Ian Cock et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Urinary tract infections (UTIs) are amongst the most common bacterial infections globally, with ∼11% of the world’s population
contracting at least one infection annually. Several South African plants are used in traditional healing systems to treat UTIs, yet
the therapeutic potential of these plants against bacteria that cause UTI remains poorly explored. This study documents southern
African plant species used traditionally to treat UTIs. An extensive literature review was undertaken to document the southern
African plant species that are used in traditional South African medicine to treat UTIs, thereby highlighting gaps in the current
research that require further study. One hundred and fifty-three southern African plant species that are used to treat UTIs were
identified. Eighty-five southern African plants were identified as having noteworthy inhibitory activity against the major UTI-
causing bacteria. Few of those studies screened against all of the bacterial causes of UTIs, and none of those studies examined the
mechanism of action of the plant preparations. Furthermore, many of those studies did not test the toxicity of the plant extracts, so
an evaluation of the safety for therapeutic usage was lacking. Substantial further research is to determine their potential for
therapeutic use.
1. Introduction anatomical differences between the genders. As the urethra
is located closer to the anus and is shorter in women than in
Urinary tract infections (UTIs) are amongst the most men, women are substantially more susceptible to infections
common human infections globally. Indeed, it has been by uropathogens [5]. Additionally, individual health status
estimated that nearly 800 million people (equating to ap- affects the incidence of UTIs. For example, immunocom-
proximately 11% of the global population) develop at least promised individuals and sufferers of chronic uncontrolled
one UTI in any given year [1, 2]. They are substantially more diabetes mellitus have substantially increased incidences of
common in women than in men, with the prevalence in UTIs as their weakened immune systems are unable to ef-
women estimated to be approximately five times higher than fectively combat infections [3].
in males [3]. Indeed, it is expected that more than half of Lifestyle and environmental factors also contribute to
female population of the world will contract at least one UTI the prevalence of UTIs. Older adults often accumulate
in their lifetime, with a substantial proportion experiencing multiple medical conditions, and their treatment and
recurrent infections [1]. With the exception of a spike in UTI management regimens may increase the risks of contracting
occurrence in women aged 14–24 years old, the prevalence UTIs. In particular, catheterisation substantially increases
of UTIs generally increases with age, with the highest in- the incidence of UTIs, especially by Gram-negative bacterial
cidence in women over 65 years of age [4]. The difference in pathogens [1]. Indeed, healthcare-associated UTIs have been
rates of UTIs between men and women is related to estimated to account for approximately 10% of UTI cases,2 Evidence-Based Complementary and Alternative Medicine
with 75% of these being reported in female patients [6, 7]. occasionally also cause UTIs. For example, Staphylococcus
Additionally, prolonged antibiotic usage to treat other aureus induces a low number of cases of UTIs, although
medical conditions weakens the immune response, thereby these are generally considered a special case as they are
increasing the susceptibility to UTIs. In younger women, usually secondary to blood S. aureus infections. UTIs can
increased sexual activity between the ages of 18 to 39 years of also be caused by fungal and viral pathogens, albeit with a
age increases both the incidence of UTIs and the frequency substantially lower prevalence than reported for bacterial
of recurrence [4]. Any region of the urinary tract may be- UTIs. In this review, we focus on the major bacterial causes
come infected, including the kidneys, bladder, urethra, and of UTIs. Therefore, whilst numerous studies have screened
ureter [8]. When the UTIs occur in the lower regions of the traditional medicines for the ability to inhibit S. aureus,
urinary tract, the infection is known as a bladder infection those studies generally focussed on other diseases (e.g., skin
(cystitis). Infections in the upper urinary tract (pyelone- disorders), and we have not listed those studies herein due to
phritis) are commonly referred to as kidney infections. the minor role of this bacterium in inducing UTIs. Likewise,
Candida albicans infections are a common cause of urethra
infections and are thus commonly classed as urethritis rather
1.1. Types of Urinary Tract Infections. Urinary tract infections
than a UTI. Therefore, we do not include studies examining
are classified as either complicated or uncomplicated.
the effects of southern African plants to inhibit C. albicans
Complicated infections occur in people with underlying
growth in this review. Numerous other studies have ex-
conditions or abnormalities in any part of the genitourinary
amined the effects of southern African plants against
tract, making the infection more serious and more chal-
C. albicans, and the reader is directed to those studies
lenging to treat than uncomplicated infections. In contrast,
[11–13]. Notably, those studies generally screened against
uncomplicated UTIs are classified as infections occurring in
C. albicans for reasons not associated with UTIs.
the absence of comorbidities or other anatomical urinary
The pathogens that cause UTIs usually enter the urinary
tract and renal abnormalities [9]. The incidence of com-
tract via the urethra. Bacteria are transferred to the urethra
plicated UTIs is substantially lower than that of uncom-
from the bowel. When they colonise the bladder, they attach
plicated UTIs, which occur in otherwise healthy people with
to the bladder wall and form a biofilm, which helps the
normal genitourinary tract anatomy [10]. However, un-
pathogens to evade the host’s immune response [14]. Im-
complicated infections are generally easier to manage, and
proper urogenital area hygiene, sexual intercourse, and
treatment with a short course of antibiotics is usually ef-
exposure to unfavourable hygiene products (e.g., scented
fective. Urinary tract infections in children and males are
and chemical filled feminine products and contraceptives)
generally categorised as uncomplicated infections due to
may aid in the introduction of pathogens to the urinary tract
their low probability of comorbidities [8]. Notably, com-
and create suitable growth conditions for infections to de-
plicated UTI-causative pathogens are linked to increased
velop [10]. Other risk factors for contracting an uncom-
rates of antimicrobial resistance. Therefore, the development
plicated UTI include sexual intercourse with a new sexual
of effective therapies to treat these conditions is vital, not
partner, use of contraceptives, and a history of previous
only to decrease the effects of these infections, but also to
recurrent UTIs. Risk factors for complicated UTIs are un-
slow the development of further antibiotic-resistant bacterial
derlying diseases, use of catheters, abnormal genitourinary
strains.
anatomy and physiology, hospitalisation, and exposure to
antibiotics [10].
1.2. Causes of Urinary Tract Infections. Interestingly, there
can be notable differences between the infectious agents
1.3. Symptoms of Urinary Tract Infections. Urinary tract
responsible for uncomplicated and complicated UTIs. The
infections may present in several ways including increased
vast majority of these pathogens are normal components of
and persistent urgency to urinate, painful burning sensations
the gastrointestinal or vaginal microflora, thereby increasing
associated with urination, increased frequency of urination,
the chances that they cause UTIs. For both classes of UTI,
lower volumes for each urinary event, and cloudy and foul
uropathogenic Escherichia coli are the leading infective
smelling urine. Pain in the lower abdomen, back, and pelvic
agent, accounting for approximately 75 and 65% for un-
area is also a relatively common symptom of UTIs, especially
complicated and complicated UTIs, respectively [1]. Kleb-
in women [8]. Occasionally, UTIs may result in blood in the
siella pneumoniae accounts for a further 6% and 8% of
urine, which may present as red-, pink-, or cola-coloured
uncomplicated and complicated UTIs. The bacterium
urine. Infection in the kidney may present with symptoms
Staphylococcus saprophyticus causes about 6% of uncom-
including nausea and vomiting, fever, and upper back pain
plicated UTIs yet does not significantly contribute to
(most commonly on a single side) [10]. Many of these signs
complicated UTIs. In contrast, Enterococcus spp. contribute
and symptoms are generic, and UTIs are frequently over-
substantially to complicated UTI cases (∼11%), yet con-
looked or misdiagnosed as other conditions, particularly in
tribute less to uncomplicated UTIs (∼6%). Other bacteria
older people.
also contribute significantly, albeit with substantially lower
rate, to the incidence of UTIs. In particular, Proteus spp.
(particularly Proteus mirabilis) and Pseudomonas aeruginosa 1.4. Current Treatments. In most cases, UTIs are relatively
each cause approximately 2% of both uncomplicated and easy to treat with a course of broad-spectrum antibiotics,
complicated cases of UTIs. Other pathogens may although fluoroquinolones (including ciprofloxacin) areEvidence-Based Complementary and Alternative Medicine 3
generally avoided as the side effects are often regarded as documented, although many of the therapies are yet to be
outweighing the benefits. The most common treatments extensively studied and verified, and substantially more
include trimethoprim/sulfamethoxazole, fosfomycin, work is needed in this field.
nitrofurantoin, cephalexin, and ceftriaxone. However, due to It is estimated that approximately 700,000 tons of plant
overuse and misuse of commonly used clinical antibiotics, materials are used each year in South Africa to produce
the emergence of antibiotic-resistant pathogens is increas- herbal remedies worth 1.2 to 2.5 billion South African Rands
ingly common, resulting in the failure of the main antibiotic annually [25–28]. Not only are these products widely used in
chemotherapy options [15]. Antibiotic resistance has been a South Africa by practitioners of traditional medicine, but
driving force of new drug development initiatives, and they are also becoming increasingly popular as comple-
implementation of alternative treatment identification and mentary and alternative medicines in combination with
new antibiotic therapies are urgently required. allopathic pharmaceuticals. Indeed, some plant products
The development of antibiotic-resistant bacteria is in- (e.g., Harpagophytum procumbens (Burch.) DC. Ex Meisn.,
creasingly resulting in antibiotic therapy failures, and commonly known as devil‘s claw extracts) are commonly
chronic UTIs are becoming more frequent [1]. Additionally, sold at pharmacies globally, and it is no longer necessary to
the relatively high rate of UTI recurrence poses a challenge visit a traditional Muthi market to obtain products devel-
to the effective treatment of these infections [16]. Indeed, oped from them. However, a substantial portion of tradi-
that study estimated that approximately 24% of people tional plant use in South Africa does use plant materials
contracting a UTI will develop a recurrent infection within obtained and prepared following traditional methods.
six months of the original infection. Of further concern, Depending on the plant species used, a variety of different
approximately 5% of people who develop a UTI will ex- parts including roots, flowers, leaves, bulbs, and stems may
perience more than three recurrences per year [17]. be used medicinally, and the individual parts may have
Foxman and Buxton [18] suggest that empirical treat- substantially different properties and uses [29]. Traditional
ments of UTIs should be reconsidered due to the following beliefs have a deep influence within the majority of the
reasons: ethnic cultures in South Africa and are particularly prevalent
in rural communities [30]. Even in urban communities, a
(i) The frequency of antibiotic-resistant E. coli strains,
large portion of the South African population is reliant on
many of which have resistance to multiple antibiotics
traditional medicine as their primary mode of healthcare
including fluoroquinolones [15], is increasing. The
[31]. Indeed, that study postulated that the demand for
increasing incidence of extended spectrum β-lacta-
traditional medicines in South Africa will increase in future
mase (ESBL) UTI pathogens that are resistant to the
years due to stress associated with urban lifestyles.
commonly used β-lactam class of antibiotics is
Despite their widespread use, there is a relative lack of
particularly concerning [19, 20].
information on the proper use and preservation of plant
(ii) Even relatively short courses of currently used an- medicines. Medicinal plants are considered (often errone-
tibiotic therapies may significantly affect the gut ously) to have fewer adverse effects [32] and are often more
microflora, resulting in other health issues devel- accessible and affordable than Western/allopathic medica-
oping [21]. These therapies may also disrupt the tions [33]. A substantial number of South Africans (espe-
urogenital microbiome, resulting in other unfore- cially rural populations) are dependent on self-medication
seen issues. Thus, the benefits of empirical antibiotic with plant-based medicines, and the involvement of the
therapy may not outweigh the risks [22, 23]. New community in managing the use and preservation of plant
and innovative strategies to prevent UTI recurrences species may result in successful strategies for sustainable use
and alternative therapies for their treatment are [34]. South African ethnobotanical literature has been rel-
considered a high priority [18]. atively well recorded, although the medicinal properties of
many species used traditionally are yet to be rigorously
verified. There has been a substantial increase in studies
1.5. The Use of Medicinal Plants in Urinary Tract Infection screening and validating the use of South African traditional
Treatment. The launch and development of the WHO medicines in recent years, highlighting the potential of
Traditional Medicine Strategy 2014–2023 aimed to support several species [35]. Of the therapeutic properties examined,
the development and implementation of proactive policies the antibacterial activity of South African plants has received
and action plans to improve the role traditional medicine the most attention, although many species remain relatively
plays in population health [24]. The strategy focuses on neglected. Numerous plants have been reported to have
developing new health systems (including the use of com- antimicrobial activity, with a substantial recent increase in
plementary and traditional medicinal products) as a high interest in this field. However, very few of those studies have
priority. A re-examination of traditional medicines is an specifically focussed on UTIs. Instead, screening against
attractive option for the development of new therapies to bacterial pathogens that cause gastrointestinal diseases
treat pathogenic infections as plant-derived medicines have [36, 37], skin disease [38, 39], or autoimmune diseases
often been used for hundreds (in some cases, thousands) of [40, 41] have received far greater attention. Notably, many of
years. Furthermore, the traditional use by some cultures has the same bacterial species screened in the other studies are
been relatively well documented. Asian, Middle Eastern, and also amongst the pathogenic causes of UTIs. Whilst the
African traditional systems are perhaps the most extensively focus of those studies is not UTIs, they are included in this4 Evidence-Based Complementary and Alternative Medicine
study as they were screened against the same bacterial (v) Only studies screening against the common causes
species. of UTIs were evaluated in this review, irrespective of
their focus. For example, studies that screened
2. Materials and Methods southern African plants against E. coli were in-
cluded in this study, even if their focus was on
This study aimed to record and document the southern gastrointestinal diseases rather than UTIs.
African medicinal plants that are used traditionally to treat
(vi) Ethnobotanical studies on the flora of southern
UTIs. A variety of ethnobotanical books [42–46], as well as
African region included South Africa and those
multiple peer reviewed journal articles, were consulted to
countries immediately surrounding it.
compile this list. The online resources Google Scholar,
PubMed, Scopus, and ScienceDirect were used to identify
and access original scientific research studies. The following 2.3. Exclusion Criteria. The following criteria were used to
terms were used as filters and were searched for both alone exclude some studies:
and as combination: “Southern Africa,” “South African,”
(i) Where name changes and families of plant species
“Lesotho,” “Swaziland,” “Namibia,” “Botswana,” “Zim-
were encountered, particularly in older publica-
babwe,” “Zambia,” “Mozambique,” “traditional medicinal
tions, websites such as The Plant List (http://www.
plant,” “ethnobotany,” “urinary tract infection,” “UTI,”
theplantlist.org/) and South African National Bio-
“bladder,” and “uropathogens.” The initial search aimed to
diversity Institute (SANBI) (http://www.sanbi.org)
document all of the plant species used in southern Africa to
were used to confirm species identification.
treat UTIs. Our study was nonbiased and did not favour the
traditional knowledge of one ethnic group over others. (ii) Plant species that were recorded to treat generic
Despite this, substantially more information was available symptoms of UTIs that are common to other ill-
about Zulu traditional medicine due to the prevalence of nesses, without specifically stating their use in
reports on that topic in the available literature. Whilst most treating UTIs, were excluded from this study.
of these species are native South African plants, introduced (iii) Studies that screened against bacteria that only
species were not excluded, where they had been incorpo- cause UTIs secondary to other diseases were ex-
rated into the traditional medicine systems of at least one cluded. Therefore, studies screening South African
South African ethnic group. Following the initial literature plants for S. aureus, which only causes UTIs sec-
review, a further review was undertaken to identify the ondary to blood S. aureus infections, were not in-
species that have been screened for their ability to inhibit one cluded in this study.
or more of the bacterial pathogens that cause UTIs. (iv) Only screening studies that tested against bacterial
pathogens were included in this study. Publications
2.1. Eligibility Criteria. Ethnobotanical books and peer that screened South African plants for fungi, viruses,
reviewed journal articles were searched using the specific key or protozoa were excluded.
words noted above. Published studies were identified and (v) The use of introduced plant species were excluded
their abstracts were read to establish their relevance to this from this study unless they are extensively used as
study. The full content of publications that were deemed part of southern African traditional medicine of at
relevant were then examined thoroughly to ensure that the least one South African ethnic group.
eligibility criteria were met.
2.4. Data Collection. A thorough literature search for
2.2. Inclusion Criteria. The following inclusion criteria for publications on southern African medicinal plants used
eligibility of the study were considered: traditionally to treat UTIs was undertaken and is sum-
(i) Publications written in English and prior to April marised in this study. Additionally, in vivo and in vitro
2021 were used in this review. biological screening of South African medicinal plants for
bacterial pathogens that cause UTIs are summarised, re-
(ii) Our study was nonbiased and without any taxo-
gardless of the origin of the study. The following data was
nomic preference.
collected for each species:
(iii) For the ethnobotanical survey (Table 1), only plant
species that are recorded to treat UTIs are included. (i) Species name, family name, and common name for
Any plants recorded to treat individual nonspecific each species recorded in the individual publications
symptoms were excluded unless it could be deter- were collected
mined that they were specifically used to treat UTIs. (ii) Common names and the names used by different
(iv) For the biological activity studies presented in Ta- ethnic groups (where appropriate) were collected
ble 2, only studies that screened against the major from individual publications and from the SANBI
bacterial causes of UTIs were included, irrespective red list website
of whether the focus of the study was UTIs or the (iii) The plant part used, method of preparation, and
bacteria tested were selected because of their as- mode of administration were recorded where that
sociation with a different disease. information was providedEvidence-Based Complementary and Alternative Medicine 5
Table 1: Southern African plants traditionally used to treat urinary tract infections.
Part of plant
Plant species Family Common name Uses References
used
Acacia sieberiana var. woodii Paperbark thorn (Eng); Bark and Urinary tract
Leguminosae [46]
(Burtt Davy) Keay & Brenan papierbasdoring (Afr) roots ailments
Acokanthera oppositifolia Urinary tract
Apocynaceae Inhlungunyembe (Zulu) Not specified [43]
(Lam.) Codd infection
Afroaster hispida (Thunb.)
Asteraceae Udlutshana (Zulu) Not specified Urinary ailments [47]
J.C.Manning & Goldblatt
Agathosma betulina Buchu (Eng); boegoe (Afr); bocho Bladder and
Rutaceae Leaves [45, 48, 49]
(P.J.Bergius) Pillans (Sotho) kidney ailments
Agathosma capensis (L.) Spicy buchu (Eng); anysboegoe,
Rutaceae Leaves Urinary ailments [50]
Dummer steenbokboegoe (Afr)
Agathosma serratifolia Langblaarboegoe, kloofboegoe Bladder and
Rutaceae Leaves [45]
(Curtis) Spreeth (Afr); long buchu (Eng) kidney ailments
Albizia adianthifolia (Schum.) Isiyengelele, usolo, Urinary tract
Leguminosae Not specified [47]
W.Wight umgadankawu (Zulu) infection
Bitteraalwyn (Afr); bitter aloe Leaves, roots, Kidney and
Aloe ferox Mill. Xanthorrhoeaceae [51]
(Eng) and stems bladder ailments
Sebra-aalwyn (Afr); zebra aloe Urinary and
Aloe zebrina Baker Xanthorrhoeaceae Leaves [46]
(Eng) bladder ailments
Antiphiona pinnatisecta
Compositae Unknown Roots Bladder ailments [46]
(S.Moore) Merxm.
Antizoma angustifolia Kidney and
Menispermaceae Maagbitterwortel (Afr) Roots [52]
(Burch.) Miers ex Harv. bladder ailments
Aptosimum procumbens
Scrophulariaceae Brandbos (Afr) Leaves Bladder ailments [42–44]
(Lehm.) Burch. ex Steud
Arctopus echinatus L. Apiaceae Platdoring (Afr) Roots Bladder ailments [42–44, 53]
Alsem (Afr); African wormwood Leaves, roots, Bladder and
Artemisia afra Jacq. ex Willd. Compositae [49, 51]
(Eng); mhlonyana (Zulu) and stems kidney ailments
Bush asparagus, African
Bladder and
Asparagus africanus Lam. Asparagaceae asparagus (Eng); katdoring (Afr); Not specified [46]
kidney ailments
isigobo (Zulu)
Asparagus asparagoides (L.) Urinary tract
Asparagaceae Makholela (Sotho) Roots [48]
Druce infection
Aster bakerianus Burtt Davy Urinary tract
Compositae Idlutshane, uhloshana (Zulu) Leaves [43]
ex C.A.Sm. infection
Baccharoides adoensis var.
Stems and Urinary tract
kotschyana (Sch.Bip. ex Compositae Innyathelo (Zulu) [43]
leaves infection
Walp.)
Bladder and
Ballota africana (L.) Benth. Lamiaceae Kattekruid (Afr) Leaves [50]
kidney ailments
Ikhakhasi, umalumvuba (Zulu); Urinary and
Berkheya Setifera DC. Compositae Root [47, 54]
leleme-la-khomo (Sotho) kidney ailments
Bolusanthus speciosus (Bolus) Umholo (Zulu); tree wisteria Barks, leaves,
Leguminosae Kidney ailments [55]
Harms (Eng); vanwykshout (Afr) and stems
Boophone disticha (L.f.) Herb. Amaryllidaceae Gifbol (Afr) Bulb Bladder ailments [42–44]
Climbing onion (Eng);
Bowiea volubilis Harv. Asparagaceae Bulb Bladder ailments [43, 48]
knolklimop (Afr); iguleni (Zulu)
Brachylaena discolor DC. Compositae Bosvaalbos (Afr); ipahla (Zulu) Leaves Urinary ailments [43]
Bulbine abyssinica A.Rich Xanthorrhoeaceae Wildekopieva (Afr) Leaves Bladder ailments [56, 57]
Bladder and
Bulbine latifolia (L.f.) Spreng. Xanthorrhoeaceae Red carrot (Eng); rooiwortel (Afr) Root [48, 57]
kidney ailments
Cardiospermum halicacabum Balloon vine (Eng); blaasklimop Stems and
Sapindaceae Bladder ailments [43, 46, 58]
L. (Afr) leaves
Carica papaya L. Caricaceae Papaya, pawpaw (Eng) Not specified Bladder ailments [42]
Buffalograss (Eng); bloubuffelgras Urinary tract
Cenchrus ciliaris L. Poaceae Roots [43, 59, 60]
(Afr); idungamuzi (Zulu) infection
Urinary and
Centaurea benedicta (L.) L. Compositae Karmedik (Afr) Not specified [50]
kidney ailments
Chironia baccifera L. Gentianaceae Bitterbos, sarsaparilla (Afr) Not specified Urinary ailments [50]6 Evidence-Based Complementary and Alternative Medicine
Table 1: Continued.
Part of plant
Plant species Family Common name Uses References
used
Chrysanthemoides monilifera Urinary and
Compositae Bietou, bessiebos (Afr) Whole plant [50]
(L.) Norl. kidney ailments
David’s root (Eng); gifhondjie, Roots and
Cissampelos capensis L.f. Menispermaceae Bladder ailments [42–44, 46]
dawidjieswortel (Afr) leaves
African cabbage, spiderwisp
Cleome gynandra L. Cleomaceae Not specified Bladder ailments [42]
(Eng); snotterbelletjie (Afr)
Wildewingerd (Afr); wild vine
Cliffortia odorata L.f. Rosaceae Leaves Bladder ailments [48]
(Eng)
Benediction lily (Eng); boslelie
Clivia miniata (Lindl.) Bosse Amaryllidaceae Bulb Urinary ailments [43]
(Afr); umayime (Zulu)
Coix lacryma-jobi L. Poaceae Job’s tears, adlay (Eng) Not specified Bladder ailments [42]
Umduba, umdubu omhlophe, Urinary and
Combretum kraussii Hochst. Combretaceae Not specified [47]
umdubo wamanzi (Zulu) bladder ailments
Idangabane (Zulu); khopo
Commelina africana L. Commelinaceae Root Bladder ailments [43]
(Sotho)
Conostomium natalense Wild pentas (Eng); umbophe,
Rubiaceae Not specified Urinary ailments [61]
(Hochst.) Bremek. ungcolosi (Zulu)
Conyza scabrida DC. Compositae Oondbos, bakbos, paddabos (Afr) Leaves Bladder infection [51]
Crinum macowanii Baker Amaryllidaceae River fly (Eng); umduze (Zulu) Bulb Urinary ailments [43]
Crinum moorei Hook. f. Amaryllidaceae Umduze (Zulu) Bulb Urinary ailments [43]
Crossyne guttata (L.) D.Müll.-
Amaryllidaceae Gifbol (Afr) Bulb Bladder ailments [42–44]
Doblies & U.Müll.-Doblies
Cryptolepis oblongifolia Bokhoring, melkbos (Afr);
Apocynaceae Not specified Bladder ailments [42]
(Meisn.) Schltr. mukangaza (Sotho)
Cussonia paniculata Eckl. & Kidney and
Araliaceae Motsetse (Sotho) Not specified [54, 62]
Zeyh. bladder ailment
Cyathula achyranthoides
Amaranthaceae Unknown Not specified Bladder ailments [63]
(Kunth) Moq.
Dog’s tooth (Eng); krookgras
Cynodon dactylon (L.) Pers. Poaceae Rhizome Urinary ailments [46]
(Afr)
Thornapple, jimsonweed, devil’s
Datura stramonium L. Solanaceae Leaves Bladder ailments [42]
snare (Eng)
Bladder and
Dicoma capensis Less. Compositae Karmedik, wilde karmedik (Afr) Leaves [44, 45, 56, 57]
kidney ailments
Bladder and
Diosma oppositifolia L. Rutaceae Buchu, Bitter buchu (Eng) Leaves [48]
kidney ailments
Urinary and
Diosma prama I.Williams Rutaceae Steenbokkboegoe (Afr) Not specified [50]
kidney ailments
Diospyros mespiliformis Ikhambi lesduli, umazambezi
Ebenaceae Not specified Urinary ailments [47]
Hochst. ex A.DC (Zulu)
Dipcadi gracillimum Baker Asparagaceae Oumasegroottoon (Afr) Not specified Bladder ailments [63]
Ugibizisila, uguleni, Urinary tract
Dipcadi viride (L.) Moench Asparagaceae Not specified [47]
umakhweyana (Zulu) infection
Dipcadi gracillimum Baker Asparagaceae Oumasegroottoon (Afr) Not specified Urinary ailments [64]
Basterolen, sandolien, ysterbos Bladder and
Dodonaea viscosa (L.) Jacq. Sapindaceae Leaves [5, 50, 51]
(Afr); sand olive (Eng) kidney ailments
Satin squill (Eng); brandui,
Drimia elata Jacq. Asparagaceae Not specified Urinary ailments [44]
jeukbol (Afr); umqumbu (Zulu)
Dysphania ambrosioides (L.) Ikhambi leslumo,
Amaranthaceae Not specified Urinary ailments [47]
Mosyakin & Clemants uzansikwesibaya (Zulu)
Elytropappus rhinocerotis Bladder and
Asteraceae Renosterbos (Afr) Leaves [49]
(L.f.) Less. kidney disorders
Elymus repens (L.) Gould Poaceae Couch grass (Eng) Not specified Bladder ailments [42]
Empleurum unicapsulare Bergboegoe, langblaarboegoe Urinary and
Rutaceae Whole plant [50]
(L.f.) Skeels (Afr) kidney ailments
Urinary and
Eriocephalus punctulatus DC. Compositae Kapokbos (Afr) Whole plant [50]
kidney ailments
Eriosema distinctum N.E.Br. Leguminosae Ubangalala omkhulu (Zulu) Roots Urinary ailments [43]Evidence-Based Complementary and Alternative Medicine 7
Table 1: Continued.
Part of plant
Plant species Family Common name Uses References
used
Coral tree (Eng); kaffirboom
Erythrina caffra Thunb. Leguminosae Leaves Urinary ailments [43]
(Afr); umsinsi (Zulu)
Erythrina lysistemon Hutch. Leguminosae Umsinsi (Zulu) Leaves Bladder ailments [47]
Urinary tract
Euclea natalensis A.DC. Ebenaceae IsiZimane, umshekisane (Zulu) Bark [47, 65]
infection
Ghwarrie, ghwarrieboom, Urinary and
Euclea undulata Thunb. Ebenaceae Whole plant [43, 50]
ghwarriebos (Afr) kidney ailments
Eucomis autumnalis (Mill.)
Asparagaceae Mathethebane (Sotho) Tubular roots Urinary ailments [58]
Chitt
Euphorbia milii Des Moul. Euphorbiaceae Crown of thorns (Eng) Not specified Bladder ailments [64, 66]
Euphorbia tithymaloides L. Euphorbiaceae Redbird flower (Eng) Not specified Bladder ailments [64, 66]
Exomis microphylla (Thunb.)
Amaranthaceae Hondepisbos, hondebossie (Afr) Whole plant Urinary ailments [50]
Aellen
Faidherbia albida (Delile)
Leguminosae Anatree (Eng); anaboom (Afr) Bark Bladder ailments [46]
A.Chev.
Vinkel, makuinkel, soetvinkel
Foeniculum vulgare Mill. Apiaceae Whole plant Urinary ailments [50]
(Afr)
Galenia africana L. Aizoaceae Kraalbos (Afr) Leaves Bladder ailments [42–44]
Red storm (Eng); rooistorm,
Galium tomentosum Thunb. Rubiaceae Root Bladder ailments [48, 56]
doodlief (Afr)
Carpet geranium (Eng); horlosie,
Geranium incanum Burm.f. Geraniaceae bergtee, vrouetee (Afr); tlako Not specified Bladder ailments [56, 64]
(Sotho)
Grewia caffra Meisn. Malvaceae Upata, iphatha (Zulu) Roots, bark Bladder ailment [67]
Cross berry (Eng); iklolo,
Grewia occidentalis L. Malvaceae Roots Bladder ailments [43]
imahlehle (Zulu)
Grewia robusta Burch. Malvaceae Bokbos (Afr) Whole plant Urinary ailments [50]
Gunnera perpensa L. Gunneraceae Ugobho, izibu (Zulu) Not specified Bladder ailments [47]
Helichrysum crispum (L.) Bladder and
Compositae Kooigoed (Afr) Leaf [49]
D. Don kidney ailments
Helichrysum odoratissimum Phefo (Sotho); kooigoed, kooibos Leaves, roots,
Compositae Bladder ailments [50, 56]
(L.) Sweet (Afr) and stems
Helichrysum patulum (L.) Honey everlasting (Eng);
Compositae Not specified Bladder ailments [42]
D.Don kooigoed (Afr); impepho (Zulu)
Hibiscus pusillus Thunb. Malvaceae Blaasbossie (Afr) Whole plant Urinary ailments [50]
Stems and
Hibiscus mastersianus Hiern Malvaceae Monarch rosemallow (Eng) Urinary ailments [46]
Leaves
Pink mallow (Eng); indola
Hibiscus pedunculatus L.f. Malvaceae Leaves Urinary ailments [43]
ebomvu (Zulu)
Bird gooseberry (Eng);
Hoslundia opposita Vahl Lamiaceae Not specified Urinary ailments [46]
uyaweyawe (Zulu)
Hypoxis hemerocallidea
Hypoxidaceae Inkanfe (Zulu); yellow star (Eng) Not specified Bladder ailments [47, 50]
Fisch., C.A.Mey. & Avé-Lall.
Ilabatheka, inkomfe, umhungulo
Hypoxis rigidula Baker Hypoxidaceae Not specified Bladder ailments [47, 50]
(Zulu); African potato (Eng)
Indigofera cassioides DC. Leguminosae Unknown Not specified Bladder ailments [42]
Beach morning glory, goat’s foot
Ipomoea pes-caprae (L.) R.Br. Convolvulaceae Not specified Bladder ailments [42]
(Eng); strandpatat (Afr)
Jasminum abyssinicum
Oleaceae Mthundangazi Roots Bladder ailments [68]
Hochst. ex DC.
Tubular roots Urinary tract
Kedrostis capensis A. Meeuse Cucurbitaceae Sesepa sa linoha (Sotho) [69]
and leaves infection
Ledebouria marginata (Baker) Urinary tract
Asparagaceae Bokhoe (Sotho) Root bulb [70]
Jessop infection
Stems with
Bladder and
Leonotis leonurus (L.) R.Br. Lamiaceae Klip dagga, wild dagga (Afr) leaves and [49]
kidney disorders,
flowers
Lessertia frutescens (L.) Kidney and
Leguminosae Kalkoenblom, keurtjie (Afr) Leaves [50, 56]
Goldblatt & J.C.Manning urinary ailments8 Evidence-Based Complementary and Alternative Medicine
Table 1: Continued.
Part of plant
Plant species Family Common name Uses References
used
Matricaria chamomilla L. Compositae Chamomile (Eng) Not specified Bladder ailments [42]
Urinary tract
Melianthus pectinatus Harv. Melianthaceae Kriekiebos, lidjiebos (Afr) Root [56]
infection
Wild mint (Eng); ufuthana Bladder and
Mentha longifolia (L.) L. Lamiaceae Leaves [49, 52, 68]
lomhlanga (Zulu) kidney ailments
Merwilla plumbea (Lindl.) Inguduza, untabosizi, untangana
Asparagaceae Not specified Bladder ailments [47, 50]
Speta zibomvana (Zulu)
Mesembryanthemum
Aizoaceae Ibohlololo (Zulu) Leaves Bladder ailment [44, 47, 53]
cordifolium L.f.
Common ice plant, crystalline ice
Mesembryanthemum
Aizoaceae plant (Eng); soutslaai, Not specified Bladder ailments [42]
crystallinum L.
volstruisslaai (Afr)
Mikania capensis DC. Compositae Umdlonzo, umhlozo (Zulu) Leaves Urinary ailments [42, 43]
Millettia oblata Dunn Leguminosae Unknown Roots Bladder ailments [42]
Notobubon galbanum (L.) Blister bush (Eng); bergseldery Kidney and
Apiaceae Not specified [42, 52]
Magee (Afr) bladder ailment
Blue water lily (Eng);
Urinary tract
Nymphaea nouchali Burm.f. Nymphaeaceae blouwaterlelie (Afr); izubu, iziba, Leaves [46, 47, 49]
infection
ugobho (Zulu)
Hoary basil (Eng); wilde Urinary tract
Ocimum americanum L. Lamiaceae Not specified [46]
basielkruid (Afr) infection
Ocotea bullata (Burch.) Stinkwood, laurel wood (Eng);
Lauraceae Bark Urinary ailments [43, 58]
E. Meyer in Drege umnukani, umhlungulu (Zulu)
Wild olive (Eng); olyfhout,
Roots and Urinary tract
Olea europaea L. Oleaceae olienhout (Afr); isadlulambezo [43, 46]
bark infection
(Zulu)
Snuff-box tree (Eng);
Oncoba spinosa Forssk. Salicaceae Not specified Bladder ailments [42]
snuifkalbassie (Afr)
Foie e kubedu (Sepedi); mudoro
Opuntia ficus-indica (L.) Mill. Cactaceae Roots Urinary ailments [63]
(Venda)
Pedalium murex L. Pedaliaceae Large caltrops (Eng) Leaves Bladder ailments [42]
Leaves and Bladder and
Pegolettia baccharidifolia Less. Compositae Ghwarrieson, heuningdou (Afr) [44, 45]
twigs kidney ailments
Pelargonium grossularioides Rooirabas (Afr); gooseberry- Leaves and Urinary tract
Geraniaceae [51, 68]
(L.) L’Hér. leaved Pelargonium (Eng) stems infection
Pelargonium hypoleucum Urinary tract
Geraniaceae Rooirabas (Afr) Roots [56]
Turcz. infection
Pelargonium ramosissimum Leaves and Bladder and
Geraniaceae Dassieboegoe, dassiebos (Afr) [51, 68]
Willd. stems kidney ailments
Pentanisia prunelloides Sooibrandbossie (Afr); Bladder and
Rubiaceae Roots [43]
(Klotzsch) Walp. icimamlilo (Zulu) kidney ailments
Petroselinum crispum (Mill.)
Apiaceae Pietersielie (Afr); parsley (Eng) Leaves Bladder ailments [49, 66]
Nyman ex A.W.Hill.
Inkbessie (Afr); ingubivumile
Phytolacca heptandra Retz. Phytolaccaceae Not specified Urinary ailments [43]
(Zulu)
Pigweed, wild purslane (Eng); Bladder and
Portulaca quadrifida L. Portulacaceae Not specified [42, 46]
kanniedood (Afr) kidney ailments
Prunus persica (L.) Batsch Rosaceae Peach (Eng) Leaves Bladder ailments [42]
Botterblom, brandblare (Afr);
Ranunculus multifidus Forssk. Ranunculaceae Leaves Urinary ailments [43]
uxhaphozi (Zulu)
Kidney and
Rhamnus prinoides L’Hér. Rhamnaceae Mofifi (Sotho) Root [54]
bladder ailment
Wild/bitter grape (Eng);
Rhoicissus tridentata (L.f.)
Vitaceae bobbejaantou, wildedruif (Afr); Stems Urinary ailments [43, 64]
Wild & R.B.Drumm.
isinwazi (Zulu)
Rhynchosia caribaea (Jacq.) Snoutbean (Eng); rankboontjie
Leguminosae Roots Urinary ailments [46]
DC. (Afr); isihlahlasenqomfi (Zulu)
Least snoutbean, burn-mouth-
Rhynchosia minima (L.) DC. Leguminosae Roots Bladder ailments [46]
vine (Eng)Evidence-Based Complementary and Alternative Medicine 9
Table 1: Continued.
Part of plant
Plant species Family Common name Uses References
used
Rhynchosia sublobata
Leguminosae Twiner of barren ground (Eng) Roots Bladder ailments [46]
(Schum.) Meikle
Urinary and
Ricinus communis L. Euphorbiaceae Olieboom, olieblaar (Afr) Leaves [47, 50]
kidney ailments
Rotheca hirsuta (Hochst.) Butterfly bush, wild violet (Eng);
Lamiaceae Not specified Urinary ailments [64]
R.Fern umathanjana, lusikisiki (Zulu)
Urinary tract
Ruta graveolens L. Rutaceae Wynruit (Afr) Leaves infection and [49, 56]
bladder ailments
Salix woodii Seemen Salicaceae Wild willow (Eng) Bark Urinary ailments [69]
Cape willow (Eng); vaalwilger
Salix mucronata Thunb. Salicaceae Bark Bladder ailments [46]
(Afr)
Toothbrush tree, real mustard Urinary tract
Salvadora persica L. Salvadoraceae Roots [46]
tree (Eng); kerriebos (Afr) infection
Baby sage, Graham’s sage,
Salvia microphylla Kunth Lamiaceae Roots Urinary ailments [50]
blackcurrant sage (Eng)
Scadoxus puniceus (L.) Friis & Idumbe likahloyile, uhloyile,
Amaryllidaceae Not specified Urinary ailments [47]
Nordal umphompo (Zulu)
Urinary tract
Gifappel (Afr); umthuma,
Solanum aculeastrum Dunal Solanaceae Fruit infection and [47, 48]
untumane (Zulu)
kidney ailments
Sutherlandia frutescens (L.) Leaves and Bladder and
Fabaceae Keurtjies, kankerbossie (Afr) [49]
R.Br. stems kidney ailments
Camphor bush (Eng); wilde
Tarchonanthus camphoratus
Compositae kanferbos (Afr); igceba elimhlope Not specified Urinary ailments [64]
L.
(Zulu)
Teucrium trifidum Retz. Lamiaceae Katjiedriebaar (Afr) Leaves Bladder ailments [56, 57]
Thesium hystrix A.W.Hill Santalaceae Kleinswartstorm (Afr) Roots Bladder ailments [42]
Stinging nettle (Eng); ubangalala,
Tragia meyeriana Müll.Arg. Euphorbiaceae Not specified Bladder ailments [42, 43]
imbabazane (Zulu)
Tragia rupestris Sond. Euphorbiaceae Ubangalala, imbabazane (Zulu) Roots Bladder ailments [43]
Red rash (Eng); basteressenhout
Trichilia emetica Vahl Meliaceae Bark Kidney ailments [43]
(Afr); ixolo, umkhuhlu (Zulu)
Erasmus clover, wild clover
Trifolium africanum Ser. Leguminosae (Eng); wildeklawer (Afr); Not specified Bladder ailments [63]
moqoiqoi, moqophi (Sesotho)
Typha capensis (Rohrb.) Bladder and
Typhaceae Papkuil (Afr) Not specified [46]
N.E.Br. kidney ailments
Small nettle (Eng); dog nettle
Urtica urens L. Urticaceae Bark Bladder pains [58]
Eng)
Warburgia salutaris
Canellaceae Isibaha (Zulu) Leaves Urethral ailments [67]
(G.Bertol.) Chiov.
Withania somnifera (L.) Winter cherry (Eng); geneesblaar
Solanaceae Roots Bladder ailments [46]
Dunal (Afr)
Xanthium strumarium L. Compositae Kankerroos (Afr) Not specified Bladder ailments [42]
Xysmalobium undulatum (L.)
Apocynaceae Wild cotton (Eng); melkbos (Afr) Not specified Bladder ailments [46]
W.T.Aiton
Arum lilies, calla lilies, pig lily
Zantedeschia albomaculata
Araceae (Eng.); varkblom (Afr); Not specified Urinary ailments [54, 62–64]
(Hook.) Baill.
mohalalitoe (Sotho)
Zea mays L. Poaceae Corn (Eng); umbila (Zulu) Not specified Bladder ailments [42]
Microsoft Excel was used for statistical data analysis. traditionally been passed down from generation to gener-
ation by word of mouth, and some of this knowledge has
3. Results now been recorded in ethnobotanical publications, although
it is likely that substantial information is not yet readily
3.1. Plants Used Traditionally to Treat Urinary Tract Infections. available. A total of 153 plants from fifty-two families were
Numerous South African plant species have been recorded recorded in the literature for the treatment of UTIs (Table 1).
to treat pathogenic diseases. This knowledge has Out of the fifty-two families, Compositae had the greatest10 Evidence-Based Complementary and Alternative Medicine
Table 2: Plant species with noteworthy activity that have been tested against urinary tract bacterial pathogens.
Plant part Pathogens
Plant species MIC values Toxicity evaluation References
used screened
Non-toxic in Artemia
Acacia karoo Hayne Leaves E. coli (M) 414 μg/mL; (W) 458 μg/mL [71]
lethality assay
Root and Root and bark: (E) 780 μg/mL; (W)
Acacia nicolitica (L.) Delile E. coli Not determined [72]
bark 6250 μg/mL
Root and Root and bark: (E) 92–780 μg/mL; (W)
Acacia sieberiana DC. E. coli Not determined [72]
bark 1560 μg/mL
Not toxic in human
E. coli (W) > 8000 μg/mL [73]
Agathosma betulina (Berg.) epithelial kidney cells
Leaves
Pillans K. pneumoniae (M) 1876 μg/mL; (W) 2387 μg/mL Non-toxic in Artemia [41]
P. mirabilis (M) 878 μg/mL lethality assay [40]
Leaves: (M) 63 μg/mL; (E) 63 μg/mL
E. coli
Stem (M) 63 μg/mL; (E) 63 μg/mL
Leaves: (M) 125 μg/mL; (E) 125 μg/mL
Alchornea cordifolia K. pneumoniae
Leaves, Stem (M) 125 μg/mL; (E) 125 μg/mL
(Schumach. And Thonn.) Not determined [74]
stem Leaves: (M) 125 μg/mL; (E) 125 μg/mL
Müll. Arg. P. mirabilis
Stem (M) 125 μg/mL; (E) 250 μg/mL
S. Leaves: (M) 63 μg/mL; (E) 63 μg/mL
saprophyticus Stem (M) 63 μg/mL; (E) 63 μg/mL
Leaves: (M) 125 μg/mL; (E) 125 μg/mL
E. coli Roots: (M) 500 μg/mL; (E) 500 μg/mL
Stem: (M) 500 μg/mL; (E) 250 μg/mL
Leaves: (M) 63 μg/mL; (E) 63 μg/mL
K. pneumoniae Roots: (M) 125 μg/mL; (E) 125 μg/mL
Leaves, Stem: (M) 500 μg/mL; (E) 500 μg/mL
Alchornea laxiflora (Benth.) LC50 � 100–140 μg/mL in
roots, Leaves: (M) 8000 μg/mL; (E) 2000 μg/ [74]
Pax & Hoffm. HeLa cells
stem mL
P. mirabilis
Roots: (M) 250 μg/mL; (E) 250 μg/mL
Stem: (M) 4000 μg/mL; (E) 4000 μg/mL
Leaves: (M) 63 μg/mL; (E) 63 μg/mL
S.
Roots: (M) 63 μg/mL; (E) 63 μg/mL
saprophyticus
Stem: (M) 63 μg/mL; (E) 63 μg/mL
Not toxic in human
Aloe ferox Mill. Leaves E. coli (W) > 8000 μg/mL [73]
epithelial kidney cells
E. coli (M) 1250 μg/mL
Aloe marlothii A.Berger Leaves Not determined [75]
P. aeruginosa (M) 1250 μg/mL
Apodytes dimidiata E.Mey E. coli (A) 2500 μg/mL
Not stated Not determined [76]
ex am. P. aeruginosa (A) 310 μg/mL
Artemisia afra Jacq. Ex Not toxic in human
Leaves E. coli (W) 3000 μg/mL [74]
Willd. epithelial kidney cells
K. pneumoniae (M) 438 μg/mL; (W) 379 μg/mL Non-toxic in Artemia [41]
Ballota africana (L.) Benth. Leaves
P. mirabilis (M) 4278 μg/mL lethality assay [40]
Bolosanthus speciosis LC50 � 53 μg/mL in Vero
Leaves E. coli (A) 80 μg/mL [77]
(Bolus) Harms cells
E. coli (A) 630 μg/mL
Brachylaena discolor Not stated Not determined [76]
P. aeruginosa (A) 310 μg/mL
Calpurnia aurea (aiton) LC50 � 57 μg/mL in Vero
Leaves E. coli (A) 40 μg/mL [77]
Benth. cells
P. mirabilis (M) 205 μg/mL; (W) 561 μg/mL
Carpobrotus edulis (L.) N.E. Non-toxic in Artemia
Leaves Proteus [40]
Br. (M) 670 μg/mL; (W) 1246 μg/mL lethality assay
vulgaris
Cissius quadrangularis E. coli (M) 1259 μg/mL
Stems Not determined [75]
(Linn.) P. aeruginosa (M) 2500 μg/mL
Clausena anisata (Willd.) E. coli (A) 310 μg/mL
Not stated Not determined [76]
Hook ex Benth. P. aeruginosa (A) 310 μg/mL
Clerodendron glabrum E. coli (A) 310 μg/mL
Not stated Not determined [76]
E.Mey P. aeruginosa (A) 630 μg/mLEvidence-Based Complementary and Alternative Medicine 11
Table 2: Continued.
Plant part Pathogens
Plant species MIC values Toxicity evaluation References
used screened
Combretum kraussii Root and bark: (E) 1560 μg/mL; (W)
Leaves E. coli Not determined [72]
Hochst. 3125 μg/mL
Cremaspora triflora LC50 � 14 μg/mL in Vero
Leaves E. coli (A) 50 μg/mL [77]
(Thonn.) K.Schum. cells
(M) 4000 μg/mL; (W) > 8000 μg/mL;
E. coli (D) > 8000 μg/mL; (EA) > 8000 μg/mL;
(H) > 8000 μg/mL
Cryptocarya latifolia Sond. Bark Not determined [78]
(M) 4000 μg/mL; (W) > 8000 μg/mL;
P. aeruginosa (D) > 8000 μg/mL; (EA) 2000 μg/mL;
(H) 4000 μg/mL
Curtisia dentata (Burm.f ) E. coli (A) 600 μg/mL
Not stated Not determined [79]
C.A. Sm. P. aeruginosa (A) 600 μg/mL
E. coli (M) 1250 μg/mL
Cussonia spicata Thunb. Bark Not determined [75]
P. aeruginosa (M) 1250 μg/mL
E. coli (A) 880 μg/mL
Cussonia zuluensis Strey. Not stated Not determined [79]
P. aeruginosa (A) 880 μg/mL
Cyathea dregei (Kunze.) E. coli (A) 310 μg/mL
Not stated Not determined [76]
R.M.Tyron P. aeruginosa (A) 310 μg/mL
Dicerocaryum ericarpum E. coli (M) 1250 μg/mL
Shoots Not determined [75]
(Decne.) P. aeruginosa (M) 1250 μg/mL
(M) 1000 μg/mL; (W) > 8000 μg/mL; Non-toxic in Artemia
Ekebergia capensi Sparrm. Leaves E. coli [80]
(D) 1000 μg/mL lethality assay
Ekebergia pterophylla (M) 1000 μg/mL; (W) > 8000 μg/mL; Non-toxic in Artemia
Leaves E. coli [80]
(C.DC) Hofmeyr (D) 4000 μg/mL lethality assay
Elaeodendron croceum LC50 � 5 μg/mL in Vero
Leaves E. coli (A) 110 μg/mL [77]
(Thunb.) DC. cells
(M) 1750 μg/mL; (D) 1750 μg/mL;
E. coli
Euclea crispa (Thunb.) (EA) 1280 μg/mL
Leaf Not determined [81]
Gürke (M) 2000 μg/mL; (D) 2000 μg/mL;
P. aeruginosa
(EA) 1500 μg/mL
(M) 1250 μg/mL; (D) 1750 μg/mL;
E. coli
(EA) 1380 μg/mL
Euclea natalensis A. DC. Leaf Not determined [81]
(M) 1000 μg/mL; (D) 2000 μg/mL;
P. aeruginosa
(EA) 2000 μg/mL
(M) > 8000 μg/mL; (W) > 8000 μg/mL;
E. coli (D) > 8000 μg/mL; (EA) > 8000 μg/mL;
Eucomis autumnalis (Mill.) (H) > 8000 μg/mL
Bulb Not determined [78]
Chitt. (M) > 8000 μg/mL; (W) > 8000 μg/mL;
P. aeruginosa (D) > 8000 μg/mL; (EA) > 8000 μg/mL;
(H) 2000 μg/mL
Root and Root and bark: (E) 1560 μg/mL; (W)
Ficus sur Forssk. E. coli Not determined [72]
bark 4600 μg/mL
Gymnosporia senegalensis (M) 156 μg/mL; (W) 312 μg/mL; (E)
Roots E. coli Not determined [82]
(Lam.) Loes. 156 μg/mL; (A) 312 μg/mL
(M) > 8000 μg/mL; (W) > 8000 μg/mL;
E. coli (D) > 8000 μg/mL; (EA) > 8000 μg/mL;
(H) > 8000 μg/mL
Hydnora africana Thunb. Bark Not determined [78]
(M) 2000 μg/mL; (W) > 8000 μg/mL;
P. aeruginosa (D) > 8000 μg/mL; (EA) > 8000 μg/mL;
(H) > 8000 μg/mL
Heteromorpha arborescens LC50 � 81 μg/mL in Vero
Leaves E. coli (A) 180 μg/mL [77]
(Spreng.) Cham & Schltdl. cells
Hetromorpha trifoliata E.coli (A) 630 μg/mL
Not stated Not determined [76]
Wendl. Eckl. & Zeyh. P. aeruginosa (A) 630 μg/mL12 Evidence-Based Complementary and Alternative Medicine
Table 2: Continued.
Plant part Pathogens
Plant species MIC values Toxicity evaluation References
used screened
Non-toxic in Artemia
Heteropyxis natalensis Harv. Leaves E. coli (M) 382 μg/mL [71]
lethality assay
Hypericim roeperianum LC50 � 66 μg/mL in Vero
Leaves E. coli (A) 130 μg/mL [77]
G.W.Schimp. ex A. Rich. cells
(M) 4000 μg/mL; (W) 4000 μg/mL; (D)
E. coli > 8000 μg/mL; (EA) > 8000 μg/mL;
Hypoxis hemerocallidea (H) > 8000 μg/mL
Leaves Not determined [78]
Fisch.Mey. & avé-Lall. (M) > 8000 μg/mL; (W) > 8000 μg/mL;
P. aeruginosa (D) > 8000 μg/mL; (EA) > 8000 μg/mL;
(H) > 8000 μg/mL
Whole (M) 78 μg/mL; (E) 146 μg/mL; (A)
Indigofera daleoides Harv. E. coli Not dertermined [82]
plant 78 μg/mL
E. coli (A) 160 μg/mL
Indigofera frutescens Linn. f. Not stated Not determined [76]
P. aeruginosa (A) 310 μg/mL
E. coli (M) 630 μg/mL
Jatropha zeheri Sond. Root Not determined [75]
P. aeruginosa (M) 2500 μg/mL
E. coli (M) 827 μg/mL; (W) 681 μg/mL [71]
Kigelia africana (Lam.) Non-toxic in Artemia
Leaves K. pneumoniae (M) 965 μg/mL; (W) 663 μg/mL [41]
Benth. lethality assay
P. mirabilis (M) 2483 μg/mL; (W) 285 μg/mL [40]
Leucosidea sericea Eckl. & E. coli (A) 80 μg/mL
Not stated Not determined [76]
Zeyh. P. aeruginosa (A) 20 μg/mL
E. coli (M) 439 μg/mL; (W) 192 μg/mL [71]
K. pneumoniae (M) 538 μg/mL; (W) 654 μg/mL [41]
Lippia javanica (Burm.f.) Non-toxic in Artemia
Leaves P. mirabilis (M) 313 μg/mL; (W) 1873 μg/mL [40]
Spreng. lethality assay
Proteus
(M) 926 μg/mL; (W) 1728 μg/mL [40]
vulgaris
E. coli (A) 40–310 μg/mL LC50 � 2.4 μg/mL in Vero
Maesa lanceolata Forssk. Leaves [76, 77]
P. aeruginosa (A) 20–310 μg/mL cells
Melletia grandis (E.Mey.) E. coli (A) 310 μg/mL
Not stated Not determined [76]
Skeels P. aeruginosa (A) 310 μg/mL
E. coli (A) 310 μg/mL
Melia azedarach L. Not stated Not determined [76]
P. aeruginosa (A) 630 μg/mL
LC50 � 41 μg/mL in Vero
Morus mesozygia Stapf. Leaves E. coli (A) 70 μg/mL [77]
cells
Nymania capensis (Thunb.) (M) > 8000 μg/mL; (W) > 8000 μg/mL; Non-toxic in Artemia
Leaves E. coli [80]
Lindb. (D) > 8000 μg/mL lethality assay
(M) 156 μg/mL; (W) 156 μg/mL; (E)
Ozoroa insignis Delile Stem bark E. coli Not determined [82]
156 μg/mL; (A) 156 μg/mL
Non-toxic in Artemia
Pelargonium sidoides DC. Leaves E. coli (W) > 8000 μg/mL [73]
lethality assay
Pittosporum viridiflorum LC50 � 55 μg/mL in Vero
Leaves E. coli (A) 110 μg/mL [74]
Sims cells
Pelargonium fasiculata (L.) K. pneumoniae (M) 374 μg/mL; (W) 432 μg/mL Non-toxic in Artemia [41]
Leaves
Alton P. mirabilis (M) 806 μg/mL; (W) 1843 μg/mL lethality assay [40]
E. coli (M) 630 μg/mL
Ptaerocarpus angolensis DC. Bark Not determined [75]
P. aeruginosa (M) 2500 μg/mL
K. pneumoniae (M) 1977 μg/mL [41]
Ptaeroxylon obliquim P. mirabilis (M) 239 μg/mL; (W) 487 μg/mL Non-toxic in Artemia
Leaves
(Thunb.) Radlk. Proteus lethality assay [40]
(M) 511 μg/mL; (W) 727 μg/mL
vulgarisEvidence-Based Complementary and Alternative Medicine 13
Table 2: Continued.
Plant part Pathogens
Plant species MIC values Toxicity evaluation References
used screened
(M) > 8000 μg/mL; (W) > 8000 μg/mL;
E. coli (D) > 8000 μg/mL; (EA) > 8000 μg/mL;
Prunus africana (Hook. f.) (H) > 8000 μg/mL
Roots Not determined [78]
Kalkman (M) > 8000 μg/mL; (W) > 8000 μg/mL;
P. aeruginosa (D) > 8000 μg/mL; (EA) > 8000 μg/mL;
(H) > 8000 μg/mL
(M) 78 μg/mL; (W) 78 μg/mL; (E)
Punica granatum L. Roots E. coli Not determined [82]
78 μg/mL; (A) 78 μg/mL
Leaves E. coli (M) 400 μg/mL
Rhicinus communis Linn. Not determined [75]
and stem P. aeruginosa (M) 780 μg/mL
Rhoicissus rhomboidea (E. Non-toxic in Artemia
Leaves E. coli (M) 306 μg/mL; (W) 333 μg/mL [71]
Mey ex Harv.) Planch. lethality assay
(M) > 8000 μg/mL; (W) > 8000 μg/mL;
E. coli (D) > 8000 μg/mL; (EA) > 8000 μg/mL;
Rhoicissus tridentata (L.f.) (H) > 8000 μg/mL
Roots Not determined [78]
Wild & R.B.Drumm. (M) 2000 μg/mL; (W) > 8000 μg/mL;
P. aeruginosa (D) > 8000 μg/mL; (EA) > 8000 μg/mL;
(H) > 8000 μg/mL
E. coli (A) 13130 μg/mL
Riccinus communis L. Leaves P. aeruginosa (M) 14670 μg/mL; (E) 16670 μg/mL Not determined [83]
K. pneumoniae (M) 12670 μg/mL; (A) 11670 μg/mL
Sacrostemma viminale R. E. coli (M) 1250 μg/mL
Stem Not determined [75]
Br. P. aeruginosa (M) 1250 μg/mL
E. coli (M) 310 μg/mL
Schkuhria pinnata (Lam.) Shoots Not determined [75]
P. aeruginosa (M) 1250 μg/mL
(M) 505 μg/mL; (W) 312 μg/mL; (E) Non-toxic in Artemia
Schotia bractopetalia Sond. Leaves E. coli [71]
491 μg/mL; (A) 312 μg/mL lethality assay
(M) 156 μg/mL; (W) 312 μg/mL; (E)
Spirostachys africana Sond. Stem bark E. coli Not determined [82]
156 μg/mL; (A) 156 μg/mL
E. coli (M) 499 μg/mL; (W) 790 μg/mL [71]
(M) 312 and 387 μg/mL (bark and
leaves respectively); (W) 387 and
K. pneumoniae [41]
335 μg/mL (bark and leaves
respectively)
(M) 969 and 474 μg/mL (bark and
Syzygium cordatum Leaves Non-toxic in Artemia
leaves respectively); (W) 932 and
(Hochst.) and bark P. mirabilis lethality assay [40]
49 μg/mL (bark and leaves
respectively)
(M) 751 and 641 μg/mL (bark and
leaves respectively); (W) 1325 and
P. vulgaris [40]
658 μg/mL (bark and leaves
respectively)
Strychnos madagascariensis Non-toxic in Artemia
Leaves E. coli (M) 580 μg/mL; (W) 593 μg/mL [71]
Poir. lethality assay
E. coli (A) 40 μg/mL
Strychnos mitis S.Moore Not stated Not determined [76]
P. aeruginosa (A) 160 μg/mL
Sutherlandia frutescens (L.) Not toxic in human
Leaves E. coli (W) > 8000 μg/mL [73]
R.Br. epithelial kidney cells
Terminalia phanerophlebia E. coli (A) 80 μg/mL
Not stated Not determined [79]
Engl. & Diels, P. aeruginosa (A) 80 μg/mL
E. coli (M) 278 μg/mL; (W) 624 μg/mL [71]
Terminalia pruinoides M.A. K. pneumoniae (M) 432 μg/mL; (W) 531 μg/mL Non-toxic in Artemia [41]
Leaves
Lawson P. mirabilis (M) 313 μg/mL; (W) 224 μg/mL lethality assay
[40]
P. vulgaris (M) 926 μg/mL; (W) 379 μg/mL
Terminalia sambesiacia E. coli (A) 60 μg/mL
Not stated Not determined [79]
Engl. & Diels. P. aeruginosa (A) 60 μg/mL14 Evidence-Based Complementary and Alternative Medicine
Table 2: Continued.
Plant part Pathogens
Plant species MIC values Toxicity evaluation References
used screened
E. coli (M) 396 μg/mL; (W) 276 μg/mL [71]
Terminalia sericea Burch. ex K. pneumoniae (M) 254 μg/mL; (W) 318 μg/mL Non-toxic in Artemia [41]
Leaves
DC. P. mirabilis (M) 417 μg/mL; (W) 103 μg/mL lethality assay
[40]
P. vulgaris (M) 508 μg/mL; (W) 520 μg/mL
(M) 1000 μg/mL; (W) > 8000 μg/mL;
E. coli
(D) 8000 μg/mL Non-toxic in Artemia
Trichilia dregeana Sond. Leaves [80]
(M) 1500 μg/mL; (W) > 8000 μg/mL; lethality assay
E. faecalis
(D) 4000 μg/mL
(M) 1000 μg/mL; (W) > 8000 μg/mL; Non-toxic in Artemia
Trichilia emetica Vahl. Leaves E. coli [80, 84]
(D) 8000 μg/mL lethality assay
Roots: (M) 387 μg/mL; Leaves: (M)
E. coli [71]
30 μg/mL LC50 � 772 μg/mL in
Tulbaghia violaceae Harv. Leaves
K. pneumoniae Roots; (M) 526 μg/mL; (W) 613 μg/mL Artemia lethality assay [41]
P. mirabilis Leaves: (W) 125 μg/mL [40]
(M) 4000 μg/mL; (W) > 8000 μg/mL; Non-toxic in Artemia
Turraea floribunda Hochst. Leaves E. coli [80]
(D) 4000 μg/mL lethality assay
(M) 2000 μg/mL; (W) > 8000 μg/mL; Non-toxic in Artemia
Turraea obtusifolia Hochst. Leaves E. coli [80]
(D) 8000 μg/mL lethality assay
E. coli (A) 600 μg/mL
Vepris reflexa I. Verd. Not stated Not determined [79]
P. aeruginosa (A) 1250 μg/mL
Leaves: (M) 239 μg/mL; (W) 304 μg/
E. coli [71]
mL
(M) 624 μg/mL (bark); (W) 677 μg/mL
K. pneumoniae [41]
(bark)
Warburgia salutaris Leaves (M) 623 and 465 μg/mL (bark and Non-toxic in Artemia
(Bertol.f.) Chiov. and bark P. mirabilis leaves respectively); (W) 417 μg/mL lethality assay [40]
(bark)
(M) 450 and 688 μg/mL (bark and
P. vulgaris leaves respectively); (W) 1203 μg/mL [40]
(leaves)
(M) 156 μg/mL; (W) 312 μg/mL; (E)
Ximenia caffra Sond. Stem bark E. coli Not determined [82]
312 μg/mL; (A) 312 μg/mL
Zanthoxylem capensis E. coli (A) 310 μg/mL
Not stated Not determined [76]
(Thunb.) Harv. P. aeruginosa (A) 310 μg/mL
E. coli (M) 2500 μg/mL
Ziziphus murconata Willd. Bark Not determined [75]
P. aeruginosa (M) 1250 μg/mL
representation, with nineteen species reported as treatments study were cited by multiple sources as traditional UTI
for UTIs (Figure 1). Leguminosae were also commonly used therapies, indicating that screening and validation of those
as UTI therapies, with fourteen plant species reported species should be prioritised.
[42, 43]. Asparagaceae, Rutaceae, and Lamiaceae were also The main plant parts used to prepare therapies to treat
well represented, with eight, six, and six species used to treat UTIs are leaves (27%), followed by roots, bulbs, and rhi-
UTIs, respectively. Five species each of Amaryllidaceae, zomes (22%) (Figure 2). For 48 plant species (31%), the
Solanaceae, and Malvaceae, as well as four species of both specific plant part used was not specified in the cited lit-
Euphorbiaceae and Poaceae, and three species of Ger- erature. For Solanum capense L. and Pelargonium ramo-
aniaceae and Xanthorrhoeaceae were also used for this sissimum Willd., both leaves and stems were used to treat
purpose. A further twenty-four plant families were repre- UTIs, so both parts are recorded in Table 1 for that purpose
sented by two or fewer individual species. Of these, Apto- [43, 58]. Fruits were found to be the least used parts as they
simum procumbens (Lehm.) Burch. ex Steud, Arctopus are only available for short periods seasonally and may not
echinatus L., Boophone disticha (L.f.) Herb., Bowiea volubilis be always readily available.
Harv., Cardiospermum halicacabum L., Cissampelos capensis
L.f., Galenia africana L., Helichrysum odoratissimum (L.)
Sweet, and Zantedeschia albomaculata (Hook.) Baill have 3.2. Dosage and Toxicity. Long term use of medicinal plants
been cited by several sources that also experimentally val- to treat diseases has resulted in the assumption that me-
idated their use for the treatment of UTIs [47, 62, 64]. dicinal plants are nontoxic and safe for therapeutic use [39].
Approximately 47% of the plant species identified in our Of the plants specified for traditional use for UTIs (Table 1),You can also read
