title: Medical-grade honey kills antibiotic-resistant bacteria in vitro and eradicates skin colonization.
abstract: BACKGROUND
  Antibiotic resistance among microbes urgently necessitates the development of novel antimicrobial agents. Since ancient times, honey has been used successfully for treatment of infected wounds, because of its antibacterial activity. However, large variations in the in vitro antibacterial activity of various honeys have been reported and hamper its acceptance in modern medicine.
  
  
  METHODS
  We assessed the in vitro bactericidal activity of Revamil (Bfactory), a medical-grade honey produced under controlled conditions, and assessed its efficacy for reduction of forearm skin colonization in healthy volunteers in a within-subject-controlled trial.
  
  
  RESULTS
  With Bacillus subtilis as a test strain, we demonstrated that the variation in bactericidal activity of 11 batches of medical-grade honey was <2-fold. Antibiotic-susceptible and -resistant isolates of Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecium, Escherichia coli, Pseudomonas aeruginosa, Enterobacter cloacae, and Klebsiella oxytoca were killed within 24 h by 10%-40% (vol/vol) honey. After 2 days of application of honey, the extent of forearm skin colonization in healthy volunteers was reduced 100-fold (P < .001), and the numbers of positive skin cultures were reduced by 76% (P < .001).
  
  
  CONCLUSIONS
  Revamil is a promising topical antimicrobial agent for prevention or treatment of infections, including those caused by multidrug-resistant bacteria.
authors.affiliation: Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Paulus H S
authors.initials: PH
authors.lastname: Kwakman
authors.forename: Johannes P C
authors.initials: JP
authors.lastname: Van den Akker
authors.forename: Ahmet
authors.initials: A
authors.lastname: Güçlü
authors.forename: Hamid
authors.initials: H
authors.lastname: Aslami
authors.forename: Jan M
authors.initials: JM
authors.lastname: Binnekade
authors.forename: Leonie
authors.initials: L
authors.lastname: de Boer
authors.forename: Laura
authors.initials: L
authors.lastname: Boszhard
authors.forename: Frederique
authors.initials: F
authors.lastname: Paulus
authors.forename: Pauline
authors.initials: P
authors.lastname: Middelhoek
authors.forename: Anje A
authors.initials: AA
authors.lastname: te Velde
authors.forename: Christina M J E
authors.initials: CM
authors.lastname: Vandenbroucke-Grauls
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
authors.forename: Sebastian A J
authors.initials: SA
authors.lastname: Zaat
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects* / Q000254:growth & development; D006722:Honey; D006801:Humans; D008826:Microbial Sensitivity Tests; D017192:Skin Diseases, Bacterial / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents