Effectiveness of Medicinal Plant-Based Therapy in the Management of Drug-Resistant Tuberculosis: Literature Review

Background: Tuberculosis (TB) is a deadly infectious disease with the major challenge of drug resistance, particularly in resistant Mycobacterium tuberculosis (MDR-TB). Medicinal plant therapy is a potential alternative to conventional TB treatment. Objective: This review analyzes the antimycobacterial potential of medicinal plants and their application in the treatment of TB patients. Methods: This study was a systematic literature review conducted according to PRISMA guidelines. A literature search was conducted in three major electronic databases: Science Direct, Wiley, and PubMed, using the keywords “Tuberculosis Treatment,” “Herbal Medicine,” and “Multidrug-resistant Tuberculosis (MDR-TB)”. Articles included in this review were selected based on certain inclusion criteria, including publication within the last five years, quantitative research, and topic relevance. Of the 924 articles found, 4 articles met the inclusion criteria and were analyzed further. Results: Some plants, such as Crinum asiaticum and Eucalyptus camaldulensis, showed significant antimycobacterial potential against TB, including MDR-TB. Medicinal plant therapy may reduce dependence on conventional drugs and the risk of resistance. Conclusion: Medicinal plant therapy has great potential to be integrated in TB care. Nurses play an important role in educating and monitoring the effectiveness of this therapy.


INTRODUCTION
Tuberculosis (TB) is one of the world's deadliest infectious diseases, especially in developing countries (1).Despite the availability of various antituberculosis therapies, resistance to antimycobacterial drugs, especially in multidrug-resistant Mycobacterium tuberculosis (MDR-TB), remains a major challenge in the treatment of global TB (2).In this context, the use of medicinal plants as complementary therapy for TB has gained greater attention.Various studies have shown that medicinal plants have significant antimycobacterial activity and can be used as alternative or complementary therapeutic agents to conventional TB treatment (3).For example, plants such as Crinum asiaticum, Trachyspermum copticum, and Eucalyptus camaldulensis have been shown to have potential in overcoming TB infection, especially in drug-resistant strains (4).This approach not only has the potential to reduce dependence on conventional drugs that are often accom-  Corresponding Full text articlen = 13 Full text articles that were excluded on the grounds of: (n =

DISCUSSION
The results of the analyzed studies demonstrate the significant potential of using medicinal plants as complementary therapy in the treatment of tuberculosis (TB), especially in the context of increasing drug resistance.The integration of these findings into nursing practice offers a more holistic and patientcentered approach, which may improve treatment effectiveness and patient quality of life.A more detailed discussion linking the research findings to nursing elements follows.

The Role of Education in Introducing Complementary Therapies
Research conducted by Li-Yao Duan et al. (2021) showed that NBXH has a higher effectiveness than JHW in reducing histopathological lesions and the number of bacterial colonies in a mouse model infected with Mycobacterium tuberculosis (7).In nursing practice, it provides a basis for introducing patients to complementary therapy options based on medicinal plants (8).Nurses can provide education on the benefits of this herbal therapy, explaining how NBXH can be used in conjunction with conventional TB drugs to reduce side effects and improve patient adherence to treatment regimens (9).

Holistic Approach to TB Management
Studies by Phanankosi Moyo et al. (2024) showed that Crinum asiaticum has potent antimycobacterial activity, thus making it a potential agent in the treatment of TB, especially in the face of drug resistance (10).The integration of medicinal plant-based therapies such as Crinum asiaticum in TB care reflects a holistic approach that combines conventional medicine with complementary therapies (11).Nurses have an important role in adopting this approach, not only as implementers of care, but also as facilitators who help patients understand and utilize additional treatment options available (12).

Use of Essential Oils in Nursing Interventions
Essential oils such as Trachyspermum copticum and Pelargonium graveolens studied by Jalil Kardan-Yamchi et al. (2020) showed great potential in the treatment of multidrug-resistant TB (13).In a nursing context, the use of these essential oils may be considered as part of complementary therapies, which may be more acceptable to patients seeking natural remedies (14).Nurses can play a role in monitoring the patient's response to this therapy, providing appropriate advice regarding dosage and usage, as well as ensuring that the patient understands the potential benefits and risks associated with the use of essential oils (15).

Drug Resistance Management with a Multimodal Approach
Research by Ali Sami Dheyab et al. (2022) highlighted the effectiveness of Eucalyptus camaldulensis extract extracts extracted using deep eutectic solvents (DES) in fighting multidrug-resistant TB strain (16).These findings are highly relevant in the management of patients with drug resistance.Nurses can integrate the use of these herbal-based therapies into patient care plans, especially those who do not respond well to conventional treatment.In addition, nurses can also contribute to further research and the development of clinical guidelines regarding the use of these plant extracts, to ensure that the interventions applied are safe and effective (17).Overall, the results of this study emphasize the importance of adopting a more integrative and holistic approach to TB treatment, especially amidst the growing challenge of drug resistance (18).The role of nurses in educating patients, facilitating the use of complementary therapies, and monitoring the effectiveness and safety of treatment is becoming increasingly important.The use of medicinal plants and essential oils in this context not only enriches the available treatment modalities, but also provides more diverse and adaptive options for patients (19).In their implementation, nurses need to be equipped with adequate knowledge of these complementary therapies, as well as the ability to critically evaluate their benefits and risks (20).The development of clinical guidelines and specialized training for nursing staff on the use of medicinal plant-based therapies may also help improve the quality of care provided, thereby providing more optimal outcomes for patients suffering from TB (21).

CONCLUSION
This literature review reveals that medicinal plant-based complementary therapies have great potential in the management of tuberculosis (TB), especially for multidrug-resistant strains (MDR-TB).