---
title: "Natural products as adjuncts for non-tuberculous mycobacterial (NTM) infections: systematic review"
id: "pubmed-42680847"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42680847"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42680847/"
doi: "10.1007/s10482-026-02416-5"
published_at: "2026-09-02T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Natural products as adjuncts for non-tuberculous mycobacterial (NTM) infections: systematic review
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42680847
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42680847/)
- **DOI:** [10.1007/s10482-026-02416-5](https://doi.org/10.1007%2Fs10482-026-02416-5)
- **Published At:** 2026-09-02T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Non-tuberculous mycobacteria (**NTM**) are an emerging clinical threat and their treatment is challenged by **antimicrobial resistance**, biofilm formation, and prolonged regimens. - This systematic review searched major biomedical databases (PubMed, Scopus, Web of Science, Embase, Cochrane Library, Google Scholar) for studies through December 2025 to identify reports on **natural products** targeting NTM. - Study types included in vitro work, in vivo animal models, and clinical trials; methodological quality was assessed with ToxRTool (toxicology studies) and SYRCLE (animal studies) for risk of bias. - A total of 19 studies met inclusion criteria; most (n = 15) were laboratory-based investigations rather than clinical or robust animal trials. - Investigated agents spanned **essential oils**, isolated **phytochemicals**, and **probiotics**, with activity reported against NTM species including **Mycobacterium avium** and **Mycobacterium abscessus** complexes. - Specific natural agents reported with notable in vitro or adjunctive activity included Juniperus communis essential oil, Helichrysum italicum essential oil, berberine combinations, and citrus oil fractions. - Several natural products demonstrated enhanced effects when combined with conventional antimycobacterial drugs or when acting via **biofilm disruption**, suggesting potential adjunctive roles. - Animal and clinical data were limited and less conclusive; some studies reported immune benefits or imaging stability, but marked reductions in bacterial load were rare. - Overall research quality and consistency across studies were variable; the authors concluded that while in vitro findings are promising, clinical efficacy remains unproven and further rigorous experimental and clinical validation is required. - The review highlights the need for well-designed preclinical and clinical trials to establish safety, dosing, and clinical benefit of natural products in NTM management.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Respiratory Oncology, Public Health Clinical Center Affiliated to Shandong University, Jinan, 250000, China. * 2 Department of Tuberculosis, Public Health Clinical Center Affiliated to Shandong University, Jinan, 250000, China. * 3 Department of Respiratory Medicine, Qishan Hospital of Yantai City, Yantai, 264001, China. * 4 Department of Tuberculosis, Public Health Clinical Center Affiliated to Shandong University, Jinan, 250000, China. qdlvyan2025@sina.com. * 5 Naufar Center, Doha, Qatar. * 6 Arad Radman Brain Storming Co.LLC., Kerman, Iran. * 7 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. * PMID: **42680847** * DOI: [ 10.1007/s10482-026-02416-5 ](https://doi.org/10.1007/s10482-026-02416-5) Item in Clipboard Review # The role of natural products in treatment of non-tuberculous mycobacterial infections: a systematic review Shuai Guo et al. Antonie Van Leeuwenhoek. 2026. Show details Display options Display options Format Abstract PubMed PMID Antonie Van Leeuwenhoek Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Antonie+Van+Leeuwenhoek%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Antonie+Van+Leeuwenhoek%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42680847/) . 2026 Sep 2;119(10):212. doi: 10.1007/s10482-026-02416-5. ### Authors [Shuai Guo](https://pubmed.ncbi.nlm.nih.gov/?term=Guo+S&cauthor_id=42680847)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42680847/#short-view-affiliation-1 "Department of Respiratory Oncology, Public Health Clinical Center Affiliated to Shandong University, Jinan, 250000, China."), [Changwei Kou](https://pubmed.ncbi.nlm.nih.gov/?term=Kou+C&cauthor_id=42680847)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42680847/#short-view-affiliation-2 "Department of Tuberculosis, Public Health Clinical Center Affiliated to Shandong University, Jinan, 250000, China."), [Shiguang Pan](https://pubmed.ncbi.nlm.nih.gov/?term=Pan+S&cauthor_id=42680847)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42680847/#short-view-affiliation-3 "Department of Respiratory Medicine, Qishan Hospital of Yantai City, Yantai, 264001, China."), [Yan Lv](https://pubmed.ncbi.nlm.nih.gov/?term=Lv+Y&cauthor_id=42680847)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42680847/#short-view-affiliation-4 "Department of Tuberculosis, Public Health Clinical Center Affiliated to Shandong University, Jinan, 250000, China. qdlvyan2025@sina.com."), [Eied Saber Alamain Ali](https://pubmed.ncbi.nlm.nih.gov/?term=Ali+ESA&cauthor_id=42680847)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42680847/#short-view-affiliation-5 "Naufar Center, Doha, Qatar."), [Fatemeh Dehghan](https://pubmed.ncbi.nlm.nih.gov/?term=Dehghan+F&cauthor_id=42680847)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42680847/#short-view-affiliation-6 "Arad Radman Brain Storming Co.LLC., Kerman, Iran."), [Mahlagha Dehghan](https://pubmed.ncbi.nlm.nih.gov/?term=Dehghan+M&cauthor_id=42680847)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42680847/#short-view-affiliation-7 "HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.") ### Affiliations * 1 Department of Respiratory Oncology, Public Health Clinical Center Affiliated to Shandong University, Jinan, 250000, China. * 2 Department of Tuberculosis, Public Health Clinical Center Affiliated to Shandong University, Jinan, 250000, China. * 3 Department of Respiratory Medicine, Qishan Hospital of Yantai City, Yantai, 264001, China. * 4 Department of Tuberculosis, Public Health Clinical Center Affiliated to Shandong University, Jinan, 250000, China. qdlvyan2025@sina.com. * 5 Naufar Center, Doha, Qatar. * 6 Arad Radman Brain Storming Co.LLC., Kerman, Iran. * 7 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. * PMID: **42680847** * DOI: [ 10.1007/s10482-026-02416-5 ](https://doi.org/10.1007/s10482-026-02416-5) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract In the recent decades, Non-tuberculous mycobacteria (NTM) have posed an emerging clinical threat. The treatment of NTM infection poses therapeutic challenges owing to factors like drug-resistance of pathogens, presence of biofilms, and the time-consuming treatment regimens. Given high toxicity and limited efficacy of numerous established therapeutic agents, natural products have been explored extensively as alternative or adjuvant therapy for NTM. This systematic review focused on therapeutic benefits of natural products in NTM infection. Major biomedical literature databases (PubMed, Scopus, Web of Science, Embase, Cochrane Library, Google Scholar) were searched for publications till December 2025 to collect relevant articles detailing the impact of natural products on NTM organisms. We included in vitro studies, in vivo studies (animal models) and clinical trials that assessed the antimycobacterial actions of diverse natural product types. The quality and risk of bias have been appraised utilizing standard tools like ToxRTool and SYRCLE to evaluate the methodological rigor of the selected articles. Total of 19 studies were selected, the majority of which (n = 15) were laboratory-based. A variety of agents such as essential oils, isolated phytochemicals, and probiotics showed antimycobacterial activities targeting different NTM species such as M. avium and M. abscessus complexes. Several compounds such as Juniperus communis essential oil, Helichrysum italicum essential oil, berberine combinations, and citrus oil fractions, demonstrated significant activity when combined with conventional antimycobacterial agents or through the disruption of biofilm formation. Animal and clinical studies revealed less conclusive benefits, while few showed improved immunity or stable imaging, and substantial reduction in bacterial load was rarely achieved. Overall, the quality of current research is inconsistent, and further rigorous validation is needed. Although natural products show promise as antimycobacterial agents and their adjunctive actions in vitro, their clinical success remains limited and significant improvement is expected. Future rigorously planned experimental and clinical studies will need to validate the therapeutic role of these promising products in NTM management. **Keywords:** Mycobacterium abscessus; Mycobacterium avium complex; Antimicrobial resistance; Biofilms; Natural compounds; Nontuberculous mycobacteria; Phytochemicals. © 2026. The Author(s), under exclusive licence to Springer Nature Switzerland AG. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Conflict of interest: Authors declare no conflict of interest. Ethical approval and consent to participate: Not applicable. Consent for publication: Not applicable. ## Similar articles * [ Sudapyridine (WX-081) antibacterial activity against _Mycobacterium avium_ , _Mycobacterium abscessus_ , and _Mycobacterium chelonae in vitro_ and _in vivo_. ](https://pubmed.ncbi.nlm.nih.gov/38240581/) Zheng L, Wang H, Qi X, Zhang W, Wang B, Fu L, Chen X, Chen X, Lu Y.Zheng L, et al.mSphere. 2024 Feb 28;9(2):e0051823. doi: 10.1128/msphere.00518-23. Epub 2024 Jan 19.mSphere. 2024.PMID: 38240581Free PMC article. * [ Antibiotic treatment for non-tuberculous mycobacteria lung infection in people with cystic fibrosis. ](https://pubmed.ncbi.nlm.nih.gov/40145528/) Jahnke N, Waters V, Ratjen F, Smith S, Hambleton IR, Scharf N.Jahnke N, et al.Cochrane Database Syst Rev. 2025 Mar 27;3(3):CD016039. doi: 10.1002/14651858.CD016039.Cochrane Database Syst Rev. 2025.PMID: 40145528Free PMC article. * [ Comparative evaluation of molecular technologies for the identification of prevalent non-tuberculous mycobacteria in pulmonary infections: a systematic review and meta-analysis. ](https://pubmed.ncbi.nlm.nih.gov/41668446/) Chen X, Sun J, Chen X, You Y, Sechi LA, Molicotti P.Chen X, et al.Ann Med. 2026 Dec;58(1):2626123. doi: 10.1080/07853890.2026.2626123. Epub 2026 Feb 10.Ann Med. 2026.PMID: 41668446Free PMC article. * [ [Chinese expert consensus on diagnosis and treatment of non-tuberculous mycobacterial pulmonary disease complicated with bronchiectasis]. ](https://pubmed.ncbi.nlm.nih.gov/39914833/) Chinese Society of Tuberculosis, Chinese Medical Association; Chinese Throacic Society, Chinese Medical Association.Chinese Society of Tuberculosis, Chinese Medical Association, et al.Zhonghua Jie He He Hu Xi Za Zhi. 2025 Feb 12;48(2):101-115. doi: 10.3760/cma.j.cn112147-20240808-00471.Zhonghua Jie He He Hu Xi Za Zhi. 2025.PMID: 39914833Chinese. * [ Vertebral osteomyelitis caused by nontuberculous mycobacteria: a case series of 23 patients and a review of 108 cases in the literature. ](https://pubmed.ncbi.nlm.nih.gov/41935293/) Ruan W, Dang R, Yang Y, Li J, Xu L, Zhao W, An H, Sun J, Tan H.Ruan W, et al.BMC Infect Dis. 2026 Apr 4;26(1):750. doi: 10.1186/s12879-026-13183-z.BMC Infect Dis. 2026.PMID: 41935293Free PMC article.Review. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42680847) ## References 1. 1. Abavisani M, Khayami R, Hoseinzadeh M, Kodori M, Kesharwani P, Sahebkar A (2023) CRISPR-Cas system as a promising player against bacterial infection and antibiotic resistance. Drug Resist Updat 68:100948 - [DOI](https://doi.org/10.1016/j.drup.2023.100948) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/36780840/) 2. 1. Abavisani M, Sajjadi SM, Ebadpour N, Kesharwani P, Karav S, Sahebkar A (2025) RNA-based antibacterial agents: mechanisms, functional insights, and challenges in therapeutic development. Chem Eng J 520:165777 - [DOI](https://doi.org/10.1016/j.cej.2025.165777) 3. 1. Amreen Z, Shriyansha, Singh M (2025) Evaluation of antimicrobial activity of different extracts of Datura stramonium against Mycobacterium kansasii. Int J Pharm Sci Res 16(8):2380–2387 4. 1. Bae SJ, Choi JW, Park BJ, Lee J, Jo EK, Lee YH et al (2018) Protective effects of a traditional herbal extract from Stellaria dichotoma var. Lanceolata against Mycobacterium abscessus infections. PLoS ONE. - [DOI](https://doi.org/10.1371/journal.pone.0207696) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/30586458/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/6306229/) 5. 1. Cha SB, Jeon BY, Kim WS, Kim J-S, Kim HM, Kwon KW et al (2015) Experimental reactivation of pulmonary Mycobacterium avium complex infection in a modified cornell-like murine model. PLoS ONE 10(9):e0139251 - [DOI](https://doi.org/10.1371/journal.pone.0139251) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/26406237/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/4583228/) Show all 49 references ## Publication types * Systematic Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Systematic+Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Systematic+Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42680847/) * Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42680847/) #
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