Combining manuka honey and the drug amikacin in a lab-based nebulization formulation improved bacterial clearance of Mycobacterium abscessus from the lungs of cystic fibrosis patients, according to a study published in Microbiology

Scientists in the Mycobacterial Research Group at the College of Health and Life Sciences at Aston University used samples of the bacteria Mycobacterium abscessus taken from 16 infected CF patients. They then tested the antibiotic amikacin, combined with manuka honey, to discover what dosage was required to kill the bacteria.

As part of the study the team used a lab-based lung model and nebulizer – a device that produces a fine spray of liquid often used for inhaling a medicinal drug. By nebulizing manuka honey and amikacin together, it was found they could improve bacterial clearance, even when using lower doses of amikacin, which would result in less life-changing side-effects to the patient. 

In the UK, of the 10,800 people living with CF, Mycobacterium abscessus infects 13% of all patients with the condition. This new approach is advantageous not only because it has the potential to kill off a highly drug resistant infection, but because of the reduced side effects, benefitting quality of life and greatly improving survival chances for infected CF patients.  

Mycobacterium abscessus is a bacterial pathogen from the same family that causes tuberculosis, but this bug differs by causing serious lung infections in people (particularly children) with pre-existing lung conditions, such as CF and bronchiectasis, as well as causing skin and soft tissue infections. The bacteria is also highly drug resistant. 

Currently, patients are given a cocktail of antibiotics, consisting of 12 months or more of antimicrobial chemotherapy and often doesn’t result in a cure. The dosage of amikacin usually used on a patient to kill the infection is 16 micrograms per mL. But the researchers found that the new combination using manuka honey, required a dosage of just 2 micrograms per mL of amikacin – resulting in only one eighth of the original dosage of the drug being used. 

Until now Mycobacterium abscessus has been virtually impossible to eradicate in people with cystic fibrosis. It can also be deadly if the patient requires a lung transplant because they are not eligible for surgery if the infection is present. 

Commenting on their findings, lead author and PhD researcher Victoria Nolan said: “So far treatment of Mycobacterium abscessus pulmonary infections can be problematic due to its drug resistant nature. The variety of antibiotics required to combat infection result in severe side effects. However, the use of this potential treatment combining amikacin and manuka honey shows great promise as an improved therapy for these terrible pulmonary infections. There is a need for better treatment outcomes and in the future we hope that this potential treatment can be tested further.”

Dr Jonathan Cox, senior lecturer in microbiology, Aston University said: “By combining a totally natural ingredient such as manuka honey with amikacin, one of the most important yet toxic drugs used for treating Mycobacterium abscessus, we have found a way to potentially kill off these bacteria with eight times less drug than before. This has the potential to significantly reduce amikacin-associated hearing loss and greatly improve the quality of life of so many patients – particularly those with cystic fibrosis. I am delighted with the outcome of this research because it paves the way for future experiments and we hope that with funding we can move towards clinical trials that could result in a change in strategy for the treatment of this debilitating infection.” 

Dr Peter Cotgreave, chief executive of the Microbiology Society said: “The Microbiology Society is proud to support the scientific community as it explores innovative solutions to overcome the growing global challenge of antimicrobial resistance. This study demonstrates one of many ways in which microbiologists are pioneering new methods to tackle drug-resistant infections, by incorporating natural products, like manuka honey, into existing therapies.”