The Elimination Effect of Medical-Grade Honey on <i>Pseudomonas aeruginosa</i> Biofilms: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background: This systematic review aimed to evaluate the efficacy of medical-grade honey (MGH) in eliminating and inhibiting Pseudomonas aeruginosa (P. aeruginosa) biofilms, which are known for their resistance to conventional antibiotics and significant role in chronic infections. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered in PROSPERO (CRD42024614542), a systematic search was conducted across PubMed, ProQuest, Scopus, and EBSCO using terms related to P. aeruginosa, biofilm, and MGH. Inclusion criteria encompassed in vitro studies assessing MGH’s effect on P. aeruginosa biofilms, with reported outcomes including biofilm inhibition and eradication. Data extraction and risk-of-bias assessment were performed independently by two reviewers using the Quality Assessment Tool for In Vitro Studies (QUIN) tool. Publication bias was estimated through forest plot. Results: A total of 1,934 records were identified from four databases. After screening and full-text review, six in vitro studies met the inclusion criteria for qualitative synthesis, and five were eligible for meta-analysis. All studies evaluated the effect of MGH, including Manuka and Surgihoney, on P. aeruginosa biofilms using crystal violet staining and spectrophotometric analysis. Pooled results showed that MGH significantly reduced biofilm formation (standardized mean difference (SMD) = -4.98; 95% confidence interval (CI): -6.72 to -3.25) and effectively disrupted established biofilms (SMD = -4.44; 95% CI: -6.62 to -2.26). Subgroup analysis revealed stronger effects on American Type Culture Collection (ATCC) strains than clinical isolates, with low within-subgroup heterogeneity. MGH also demonstrated significant superiority compared to active biofilm controls, although sterility control comparisons showed high variability. Mechanistic analysis found that Medihoney outperformed sugar solutions and methylglyoxal (MGO) alone, suggesting that its antibiofilm activity results from synergistic bioactive compounds. Overall, these findings support MGH as a potent antibiofilm agent, warranting further research for clinical application against P. aeruginosa biofilm infections. Conclusion: MGH exhibits consistent and substantial anti-biofilm activity against P. aeruginosa in vitro, affecting both biofilm formation and established biofilms. These findings support its potential application as a topical therapeutic agent in managing biofilm-related infections, particularly in chronic wounds. Future research should prioritize standardized application protocols and investigate synergistic effects with conventional antimicrobials through clinical trials.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.023 | 0.049 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.022 | 0.045 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".