A Comparison Between Medical Grade Honey and Table Honeys in Relation to Antimicrobial Efficacy

Author(s): 
Rose A. Cooper, PhD and Leighton Jenkins, BSc; From the Centre for Biomedical Sciences, Cardiff School of Health Sciences, University of Wales Institute Cardiff, United Kingdom

Abstract: When antimicrobial agents are being evaluated prior to their introduction into clinical practice, advance publicity may interest potential users but access to that agent will normally be limited until licensed products are released and distributed. Honey is an ancient therapy that has recently been re-introduced into modern medicine. Medical grade honey (MGH) is being incorporated into sterile devices that are applied topically to wounds. Honey is universally recognized and it is readily accessible. Patients and practitioners may, therefore, consider using table honey from supermarkets as a cheap, readily available alternative to more expensive, regulated, honey-based wound care products. This study was designed to compare the antibacterial potency and microbial flora of 18 table honeys to a representative sample of Leptospermum honey (a MGH). Standardized tests of microbial content and in-vitro efficacy were conducted for each sample. Table honeys generally possessed lower antibacterial activity than the MGH and contained a wide range of microbial species, whereas MGH was sterile. The disadvantages of using non-sterile table honeys in medical practice were reviewed. Results suggest the need for randomized clinical trials verifying the efficacy and/or safety of any form of honey used in topical wound care.


Address correspondence to:
Rose A. Cooper, PhD
Centre for Biomedical Sciences, Cardiff School of Health Sciences
University of Wales Institute Cardiff, Llandaff Campus
Western Avenue, Cardiff CF5 2YB
United Kingdom
Phone: +44 (0) 2920 416845
E-mail: rcooper@uwic.ac.uk




   The development of a new antibiotic usually takes between 10 and 15 years and costs nearly $1 billion. During that time, a code number or trivial name that is meaningless to those not involved in its development identifies the agent. Although preliminary reports of its efficacy may excite potential patients, their access to the new treatment will be restricted until the launch and distribution of the fully developed and licensed product. Less expensive alternatives may not be available immediately since the bioactive component(s) may be patent protected.

   Honey is a broad-spectrum antimicrobial agent that has been used in treating wounds for thousands of years. It has been shown to inhibit the growth of a wide range of bacteria, fungi, protozoa, and viruses.1,2 Laboratory tests with medical grade honeys (MGH), particularly Leptospermum honeys such as manuka or jellybush, have demonstrated that antibiotic-sensitive bacteria and antibiotic-resistant bacteria are equally susceptible to dilute concentrations.3–6 An increasing number of reports of the eradication of methicillin-resistant Staphylococcus aureus (MRSA) from wounds illustrate the clinical efficacy of such honeys.7–11

   All honeys have a high sugar content, low water content, and acidity that prevents microbial growth. Most unprocessed honeys, when diluted slowly, generate hydrogen peroxide due to the activation of the enzyme glucose oxidase, which oxidizes glucose to gluconic acid and hydrogen peroxide.12,13 Hydrogen peroxide has antibacterial properties, but not all honeys exhibit equal activity.1

   In many honeys, heating at elevated temperatures destroys this peroxide activity and it is lost in the presence of catalase (an enzyme that degrades hydrogen peroxide and is present in wound fluid). However, Leptospermum honeys retain activity in the presence of catalase and are known as non-peroxide honeys.1 Contributions to the non-peroxide activity of Leptospermum honey by several components have been identified,14–17 but it is most likely that more have yet to be characterized.

References: 

1. Molan PC. The antibacterial nature of honey. 1.The nature of the antibacterial activity. Bee World. 1992;73(1):5–28.
2. Blair SE, Carter DA. The potential for honey in the management of wounds and infections. J Australian Infect Control. 2005;10(1):24–31.
3. Cooper RA, Molan PC, Harding KG. The sensitivity to honey of Gram-positive cocci of clinical significance isolated from wounds. J Appl Microbiol. 2002;93(5):857–863.
4. Cooper RA, Halas E, Molan PC. The efficacy of honey in inhibiting strains of Pseudomonas aeruginosa from infected burns. J Burn Care Rehab. 2002;23(6):366–370.
5. French VM, Cooper RA, Molan PC. The antibacterial activity of honey against coagulase-negative staphylococci. J Antimicrob Chemother. 2005;56(1):228–231.
6. George NM, Cutting KM. Antibacterial honey (Medihoney™): in vitro activity against clinical isolates of MRSA, VRE, and other multiresistant organisms including Pseudomonas aeruginosa. WOUNDS. 2007;19(9):231–236.
7. Dunford C, Cooper R, Molan P, White R. The use of honey in wound management. Nurs Stand. 2000;15(11):63–68.
8. Natarajan S, Williamson D, Grey J, Harding KG, Cooper RA. Healing of an MRSA-colonized, hydroxyurea-induced leg ulcer with honey. J Dermatolog Treat. 2001;12(1):33–36.
9. Chambers J. Topical Manuka honey for MRSA-contaminated skin ulcers. Palliat Med. 2006;20(5):557.
10. Visavadia BG, Honeysett J, Danford M. Manuka honey dressing: an effective treatment for chronic wounds. Br J Oral Maxillofac Surg. 2008;46(1):55–56.
11. Blaser G, Santos K, Bode U, Vetter H, Simon A. Effect of medical honey on wounds colonised or infected with MRSA. J Wound Care. 2007;16(8):325–328.
12. White JW Jr, Subers MH, Schepartz AI. The identification of inhibine, the antibacterial factor in honey, as hydrogen peroxide and its origin in a honey glucose-oxidase system. Biochim Biophys Acta. 1963;73:57–70.
13. Bang LM, Buntting C, Molan PC. The effect of dilution on the rate of hydrogen peroxide production in honey and its implications for wound healing. J Altern Complement Med. 2003;9(2):267–273.
14. Russell KM, Molan PC, Wilkins AL, Holland PT. The identification of some antibacterial constituents of New Zealand Manuka honey. J Agric Food Chem. 1988;38:10–13.
15. Senanayke M. A Chemical Analysis of New Zealand Unifloral Honeys [dissertation]. The University of Waikato; 2006.
16. Mavric E, Wittmann S, Barth G, Henle T. Identification and quantification of methylglyoxal as the dominant antibacterial constituent of Manuka (Leptospermum scoparium) honeys from New Zealand. Mol Nutr Foods Res. 2008;52(4):483–489.
17. Adams CJ, Boult CH, Deadman BJ, et al. Isolation by HPLC and characterisation of the bioactive fraction of New Zealand manuka (Leptospermum scoparium) honey. Carbohydr Res. 2008;343(4):651–659.
18. Allen KL, Molan PC, Reid GM. A survey of the antibacterial activity of some New Zealand honeys. J Pharm Pharmacol. 1991;43(12):817–822.
19. Robson V. Guidelines for the use of honey in wound management. In: White R, Cooper R, Molan P, eds. Honey: A Modern Wound Management Product. Aberdeen, UK: Wounds UK; 2005:149–155.
20. Dunford C, Cooper R, Molan P. Using honey as a dressing for infected skin lesions. Nurs Times. 2000;96(14 Suppl):7–9.
21. Cooper RA, Molan PC, Krishnamoorthy L, Harding KG. Manuka honey used to heal a recalcitrant surgical wound. Eur J Clin Microbiol Infect Dis. 2001;20(10):758–759.
22. Nevas M, Lindström M, Hörman A, Keto-Timonen R, Korkeala H. Contamination routes of Clostridium botulinum in the honey production environment. Environ Microbiol. 2006;8(6):1085–1094.
23. Yoon YM, Newlands C. Quality standards of medical grade manuka honey. In: White R, Cooper R, Molan P, eds. Honey: A Modern Wound Management Product. Aberdeen, UK: Wounds UK; 2005.
24. Molan PC. Not all honeys are the same for wound healing. European Tissue Repair Society Bulletin. 2002;9(1).
25. Molan PC. The role of honey in the management of wounds. J Wound Care. 1999;8(8):415–418.
26. Cooper RA. Using honey to inhibit wound pathogens. Nurs Times. 2008;104(3):46–48.
27. Snowdon JA, Cliver DO. Microorganisms in honey. Int J Food Microbiol. 1996;31(1-3):1–26.
28. Turnbull P, Kramer J, Melling J. Bacillus. In: Parker MT, Collier LH, eds. Topley and Wilson’s Principles of Bacteriology, Virology and Immunity. 8th ed. London: Arnold; 1990:187–210.
29. Duerden BI. The Bacteroidaceae: Bacteroides, Fusobacterium and Leptotrichia. In: Parker MT, Collier LH, eds. Topley and Wilson’s Principles of Bacteriology, Virology and Immunity. 8th ed. London: Arnold; 1990:551–575.
30. Djordjevic SP, Forbes WA, Smith LA, Hornitzky MA. Genetic and biochemical diversity among isolates of Paenibacillus alvei cultured from Australian honeybee (Apis mellifera) colonies. Appl Environ Microbiol. 2000;66(3):1098–1106.






























harold jitschak bueno de mesquitasays: June 25.2010 at 04:34 am

Interesting, but alas all bought honey was considered as “one group.” Should there have not been made a difference/comparison between non-adulterated and non-heated honey to just “any bottle named" honey? It has been accepted in Ayurveda medicine that heated honey is “toxic” [whatever that may mean in our Western terminology]. The fact that so many nutritional statements of Ayurveda have already been shown to be right would give this consideration extra weight I would think.

Reply to this comment »

Post new comment

  • Lines and paragraphs break automatically.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Use to create page breaks.

More information about formatting options

Image CAPTCHA
Enter the characters shown in the image.