Honey for the Achilles Heel

In the PD literature, peritonitis has been referred to as an Achilles’ heel because it could lead to catheter removal and PD treatment failure. Topical antibiotics have been used for prevention of an exit site infection (ESI) which may precede and lead to peritonitis.

For this purpose, most centers use mupirocin as their first choice. It has reduced the ESI significantly, but mupirocin-resistant S. aureus and P. aeruginosa ESI have emerged. Then came gentamicin which is superior to mupirocin. However, gentamicin-resistant P. aeruginosa has already been reported… How can we break this cycle?

FOOD was the bright idea! Not any food but a very specific sweet treat – honey. Honey has been applied to wounds since ancient times, but only recently have we come to understand its antibacterial properties: acidity (pH 3-4), high osmolarity (3000 mOsm/kg), H₂O₂, methyl glyoxal, bee defensin-1, etc. In vitro, honey killed bacteria including MRSA, β-lactamase producing E. Coli, ciprofloxacin-resistant P. aeruginosa and VRE! Because of its multiple antibacterial mechanisms, there is a low likelihood that bacteria will gain resistance.

But does it work in vivo? It has been shown that honey heals wounds and maintains sterility. Then, an Australian and New Zealand group tested standardized antibacterial honey (Medihoney) for HD catheter-associated infections and its effectiveness was comparable to mupirocin.

Now the same group is conducting the HONEYPOT study to see its efficacy in reducing the risk of PD infection. This is one of the initiatives to improve the PD technique survival in the region which is lower than in other parts of the world.

The results of the HONEYPOT study are pending, but it would be exciting if honey is proven to be an effective alternative prophylaxis with less chance of bacterial resistance. Penicillin was discovered from fungi. Gentamicin is synthesized by bacteria. Maybe it’s time to ask for honey bees for help.

Posted by Tomoki Tsukahara