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Review
. 2024 May 28:14:1380289.
doi: 10.3389/fcimb.2024.1380289. eCollection 2024.

Manuka honey as a non-antibiotic alternative against Staphylococcus spp. and their small colony variant (SCVs) phenotypes

Laura A Onyango  1 , Jiawei Liang  1
Affiliations
Review

Manuka honey as a non-antibiotic alternative against Staphylococcus spp. and their small colony variant (SCVs) phenotypes

Laura A Onyango et al. Front Cell Infect Microbiol. .

Abstract

The antibiotic resistance (ABR) crisis is an urgent global health priority. Staphylococci are among the problematic bacteria contributing to this emergency owing to their recalcitrance to many clinically important antibiotics. Staphylococcal pathogenesis is further complicated by the presence of small colony variants (SCVs), a bacterial subpopulation displaying atypical characteristics including retarded growth, prolific biofilm formation, heightened antibiotic tolerance, and enhanced intracellular persistence. These capabilities severely impede current chemotherapeutics, resulting in chronic infections, poor patient outcomes, and significant economic burden. Tackling ABR requires alternative measures beyond the conventional options that have dominated treatment regimens over the past 8 decades. Non-antibiotic therapies are gaining interest in this arena, including the use of honey, which despite having ancient therapeutic roots has now been reimagined as an alternative treatment beyond just traditional topical use, to include the treatment of an array of difficult-to-treat staphylococcal infections. This literature review focused on Manuka honey (MH) and its efficacy as an anti-staphylococcal treatment. We summarized the studies that have used this product and the technologies employed to study the antibacterial mechanisms that render MH a suitable agent for the management of problematic staphylococcal infections, including those involving staphylococcal SCVs. We also discussed the status of staphylococcal resistance development to MH and other factors that may impact its efficacy as an alternative therapy to help combat ABR.

Keywords: Manuka honey; Staphylococci; antibiotic resistance; coagulase-negative staphylococci; non-antibiotic therapy; small colony variants.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Number of research studies performed yearly from 1987 to 2023 where Manuka honey (MH) was tested as a non-antibiotic adjuvant product against Staphylococcus spp.
Figure 2
Figure 2
Stages thought to represent the phenotypic shift mechanism (PSM) hypothesis representative of small-colony variant (SCV) mediated infections. Symptoms cycle between manifestations of acute (WT-mediated) infections, and periods of seemingly infection resolve (due to down-regulated SCV pathogenesis). This leads to recurrent infections, characteristic of SCV-involvement.
Figure 3
Figure 3
Manuka honey’s (MH) anti-staphylococcal mechanisms. Mechanisms are representative of effects mainly observed in investigations featuring S. aureus, which currently account for the majority of the investigations.
Figure 4
Figure 4
Analysis of current clinical applications of Manuka Honey (MH). Data was retrieved from various global clinical trials databases. Of the 43 clinical trials found, studies were categorised into those involving an obvious aetiological cause versus those with no known or obvious microbial cause. Of those with no microbial cause, MH was studied as daily supplements (category 1, n=5), as an anti-inflammatory dressing (category 2, n=16), and as a treatment in other health conditions (category 3, n=5). Data was retrieved from various global clinical trials databases.
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