The Efficacy of Medical-Grade Honey as an Antimicrobial Agent Against Antibiotic-Resistant Bacteria: A Systematic Review and Meta-Analysis

Abstract

The escalating crisis of antimicrobial resistance (AMR) demands the exploration of alternative and complementary therapeutic agents. Honey, particularly medical-grade honey (MGH), has re-emerged as a promising topical antimicrobial due to its broad-spectrum activity and multi-faceted mechanism of action. To systematically review and synthesize the available in vitro evidence on the antibacterial efficacy of honey against clinically significant antibiotic-resistant bacteria. A systematic search was conducted in PubMed, Scopus, Web of Science, and EMBASE from inception until May 2023. In vitro studies reporting the minimum inhibitory concentration (MIC) of defined honey types against antibiotic-resistant bacteria (e.g., MRSA, VRE, ESBL-producing Gram-negatives) were included. The primary outcome was the pooled mean MIC. Study quality was assessed using a modified SYRCLE risk of bias tool. A random-effects meta-analysis was performed to pool MIC values, with heterogeneity assessed using the I² statistic. Of 1,250 records screened, 28 studies met the inclusion criteria, providing 412 data points for meta-analysis. The overall pooled mean MIC of honey against all antibiotic-resistant bacteria was 10.8% w/v (95% CI: 8.5 - 13.1%). Subgroup analysis revealed significantly greater potency against Gram-positive bacteria (pooled MIC: 8.2%, 95% CI: 6.5 - 9.9%), particularly MRSA, compared to Gram-negative bacteria (pooled MIC: 14.5%, 95% CI: 11.0 - 18.0%). Manuka honey demonstrated a superior pooled MIC (7.4%, 95% CI: 5.8 - 9.0%) compared to other honey types (13.1%, 95% CI: 10.2 - 16.0%). Considerable heterogeneity (I² = 89%) was observed. Medical-grade honey, especially Manuka, demonstrates potent in vitro antibacterial activity against a wide range of antibiotic-resistant pathogens at concentrations achievable in topical formulations. These findings strongly support its use as an effective topical agent for managing wound infections in the era of AMR.

Received Date: April 26, 2024                   Accepted Date: May 17, 2025                    Published Date: June 01, 2025

Available Online at https://www.ijsrisjournal.com/index.php/ojsfiles/article/view/482