The paper deals with a thorough investigation on the antimicrobial activity of RF oxygen plasma and Azadirachtin (neem extract) treated cotton fabric. The hydrophilicity of cotton fabric was found to improve when treated with RF oxygen plasma. The process parameters such as electrode gap, time of exposure and oxygen pressure have been varied to study their effect on improving the hydrophilicity of the cotton fabric. The static immersion test has been carried out to assess the hydrophilicity of the oxygen plasma treated samples and the process parameters were optimized based on these test results. The formation of carbonyl group during surface modification in the plasma treated sample was analysed using FTIR studies. The surface morphology has been studied using SEM micrographs. The antimicrobial activity was imparted to the RF oxygen plasma treated samples using methanolic extract of neem leaves containing Azadirachtin. The antimicrobial activity of these samples has been analysed and compared with the activity of the cotton fabric treated with neem extract alone. The investigation reveals that the surface modification due to RF oxygen plasma was found to increase the hydrophilicity and hence the antimicrobial activity of the cotton fabric when treated with Azadirachtin. (c) 2007 Elsevier B.V. All rights reserved.