Synergistic antifungal activity of combinations of <i>Artemisia annua</i> extract with fluconazole against resistant strains of <i>Candida albicans</i>

Purpose: To elucidate how fluconazole and the methanol extract of Artemisia annua interact to inhibit the growth of fungi. Methods: Five hundred clinical samples of Candida albicans were isolated from patients attending three tertiary health facilities in Enugu State, Nigeria, namely, University of Nigeria Teaching Hospital (UNTH), Ituku Ozala, Bishop Shanahan Hospital (BSH), Nsukka, and Enugu State University Teaching Hospital (ESUTH), Enugu. Out of the five hundred clinical samples collected, eight genetically proven C. albicans isolates were employed for this study. The synergy between Artemisia annua and fluconazole was characterized by checkerboard analyses and fractional inhibitory concentration indices (FIC). Results: Minimum inhibitory concentration (MIC) testing results show that most isolates were resistant to selected azoles employed in the study. Based on fractional inhibitory concentration (FIC) index, specific mixtures of the extract and FLU had synergistic effects on isolates of resistant Candida albicans. Conclusion: When combined with fluconazole, the extract of A. annua demonstrated better inhibition than fluconazole alone against resistant C. albicans. This suggests a promising strategy for tackling the challenge of emerging fungal antibiotic resistance.