Tuberculosis is one of the major public health problems faced globally.

Resistance of
Mycobacterium tuberculosis to antitubercular agents has called for an urgent need to
investigate newer drugs to combat tuberculosis. Garlic (Allium sativum) is an edible
plant which has generated a lot of curiosity throughout human history as a medicinal
plant. Garlic contains sulfur compounds like allicin, ajoene, allylmethyltrisulfide,
diallyltrisulfide, diallyldisulphide and others which exhibit various biological
properties like antimicrobial, anticancer, antioxidant, immunomodulatory,
antiinflammatory, hypoglycemic, and cardiovascular effects. According to various
traditional systems of medicine, garlic is one of the established remedies for
tuberculosis. The objective of the current study was to investigate in vitro
antimycobacterial activity as well as anti-bacterial activity of various extracts rich in
specific phytoconstituents from garlic. Preparation of garlic extracts was done based
on the chemistry of the constituents and their stability. The estimation of in vitro
antimycobacterial activity of different garlic extracts was done using Resazurin
microtire plate assay technique whereas activity of garlic oil was evaluated by colony
count method. The antibacterial activity of extracts and oil was estimated by zone of
inhibition method. Extracts of garlic rich in allicin and ajoene showed appreciable
antimycobacterial activity as compared to standard drugs. Garlic oil demonstrated
significant antibacterial activity, particularly against methicillin-resistant
Staphylococcus aureus.

Abstract
Emergence of multi-drug resistant (MDR) and extensively drug resistant (XDR) TB
throughout the developing world is very disturbing in the present scenario of TB
management. There is a fundamental need to explore alternative anti-TB agents.
Hence natural plants should be investigated to understand their antimicrobial
properties and safety. Garlic (Allium sativum) is one of natural plant which possesses
variety of biological properties like anti-tumor, anti-hyperlipedemic and anti-
microbial etc. The present study was evaluated for anti-bacterial activity of garlic
against non-MDR and MDR isolates of M. tuberculosis. A total of 20 clinical isolates
of MTB including 15 MDR and 5 non-MDR were investigated. Ethanolic extract of
garlic was prepared by maceration method. Minimum inhibitory concentration (MIC)
was performed by using 7H9 middle brook broth dilution technique. MIC of garlic
extract was ranged from 1 to 3 mg/ml; showing inhibitory effects of garlic against
both non-MDR and MDR M. tuberculosis isolates. Alternate medicine practices with
plant extracts including garlic should be considered to decrease the burden of drug
resistance and cost in the management of diseases. The use of garlic against MDR-TB
may be of great importance regarding public health.

Pada penelitian yang dilakukan oleh Gupta et al. (2008) menunjukkan bahwa ekstrak
A. sativum bersama dengan 4 ekstrak tanaman lain yaitu A. indica, A. vasica, A.cepa,
dan A. vera memiliki aktivitas melawan 2 isolat MDR M. Tuberculosis (DKU-156 dan
JAL-1236) di medium Lowenstein Jensen (L-J). A. indica, A. vasica, A. cepa, A.
sativum, dan A. vera memiliki daya hambat (%) berturut-turut sebesar 95, 32, 37, 72,
32 pada DKU-156 dan 68, 86, 79, 72, 85 pada JAL-1236.

Pada tahun 2006, menurut sebuah penelitian yang dilakukan oleh Universitas Aligarh
di India dan University of Cleveland di AS, allicin terbukti menjadi agen potensial
untuk melawan infeksi TB, melalui efek antiinflamasi potensial pada host sel
mononuklear yang terinfeksi MTB. Allicin meningkatkan aktivitas enzim glutathione
peroksidase sehingga mengurangi produksi Reactive Oxygen Species (ROS) dan
akhirnya menurunkan produksi mediator inflamasI (Hasan et al., 2006). Fenomena ini
dilaporkan disebabkan karena supresi trankripsi antigen 85B. Antigen 85B disekresi
oleh MTB dan bertanggung jawab terhadap induksi mediator inflamasi TNF alpha.
Supresi ekspresi 85B dengan allicin tampaknya dimediasi melalui penghambatan
glutathione (Hasan et al., 2007).

Aktivitas antituberkulosis dari ekstrak bawang putih menjadi sangat menarik dalam
kasus MDR-TB. Bahkan, beberapa tahun yang lalu Dr. R. Cutler dan Dr. P. Wilson, di
Rumah Sakit Royal London, mencatat bahwa sejumlah strain MDR-TB yang diisolasi
dari pasien tumbuh pada semua lereng di mana strain diobati dengan streptomisin,
sedangkan isolat yang sama benar-benar dihambat oleh cairan allicin (Josling et al.,
2005). Penelitian oleh Gupta et al. (2010) dilakukan untuk mengevaluasi aktivitas
antitubercular dari ekstrak air lima tanaman obat. Ekstrak air Allium sativum
ditemukan memiliki aktivitas melawan dua isolat MDR M. tuberculosis yang
ditemukan resisten terhadap rifampisin dan isoniazid (Gupta et al., 2010). Sebuah
studi oleh Hannan et al. (2011) dilakukan untuk mengevaluasi aktivitas antibakteri
bawang putih terhadap non-MDR dan TB isolat M. tuberculosis. Sebanyak 20 isolat
klinis dari MTB termasuk 15 MDR dan 5 non-MDR diselidiki. Ekstrak etanol bawang
putih dibuat dengan metode maserasi. MIC ekstrak bawang putih berkisar dari 1
sampai 3 mg/mL, menunjukkan efek penghambatan bawang putih terhadap isolat
non-MDR dan MDR M. tuberculosis (Hannan et al., 2011).