Honey May Supplement Anti-Typhoid Drugs

Manuka Honey and Its Antimicrobial Potential Against Multi-Drug Resistant Strains of Typhoidal Salmonellae
Prof. Abdul Hannan, Muhammad Barkaat, Sidrah Saleem, Muhammad Usman, Waseem Ahmed Gilani, Department of Microbiology, University of Health Sciences, Lahore, Pakistan

[Presented at 7th German Apitherapy, Apipuncture and Bee Products Congress, Expo and Workshops with International Participation in Passau, Germany, March 26-31, 2009.]

Problem: Typhoid Fever

• A global as well as local problem
• 16-33 million cases occur worldwide
• With over 500,000 to 600,000 deaths
• 93% cases occur only in Asia
• Endemic in Pakistan

Chloramphenicol was introduced in 1948 for the treatment of typhoid fever, which dramatically reduced the incidence of typhoid fever and converted a distressing, and often lethal disease into a readily manageable condition.

However, this optimism did no last very long and resistance to chloramphenicol emerged in 1950. By the 1972, widespread resistance to this drug reported, which posed a serious threat to health community.

Ampicillin and co-trimoxazole replaced chloramphenicol and became the treatment of choice at that time. However, in the late 1980s and early 1990s, S. typhi strains also developed simultaneous plasmid mediated resistance to all three first line antibiotics.

These strains disseminated globally and were designated MDR.

The situation has further aggravated with the recent emergence of fluoroquinolone resistance as well as ceftriaxone resistance. Consequently, it had become very difficult and expensive for health community to treat typhoid fever, especially in developing countries like Pakistan, where the burden of typhoid fever is already quite high.

Honey has been used as a healing agent throughout the human history besides its widespread usage as a popular food (White, 1966). Its miraculous healing properties are also mentioned in almost all Holy Scriptures.

Recently the medical profession has rediscovered its therapeutic role and has approved honey as a medicine for chronic skin infections and burns (George et al., 2007). Honey has also been successfully used for some ailments of gastrointestinal tract, including periodontal and other oral diseases (Molan, 2001).

A clinical trial indicated that honey at concentration of 5% (v/v) shortens the duration of bacterial diarrhea caused by Shigella, salmonella and Escherichia coli in infants and children (Haffejee et al., 1985). It has also been found to be effective in the treatment of dyspepsia, gastric and duodenal ulcers, caused by infection with Helicobacter pylori (Sato et al., 2000).

Honey has diverse and multiple strategies to overcome pathogenic organisms. It directly inhibits the microorganism by acidic Ph, high osmolarity, and the release of hydrogen peroxide and plant derived non-peroxide antibacterial substances.

Honey also inhibits the growth of pathogenic microorganisms by stimulating the growth of beneficial GIT flora (bacterial interference). More recently a study revealed that certain varieties of honey can promote the growth of normal microbial flora like lactobacilli and bifidobacterium species. This is not the case with antibiotics, which affect not only the pathogenic microorganisms but also inhibit the growth of normal flora.

Thus, treatment with antibiotics can create an imbalance, which itself may lead to serious drug-resistant infections. Honey also prevents the adherence of salmonella to intestinal epithelium and recently identified MGO protects the intestinal mucosa from injurious stimuli and stimulates the immune system as well. Above all honey does not allow micro-organism to develop resistance unlike the conventional antibiotics.

Hypothesis:

• Honey contains potent antibacterial substances against multi-drug resistant Typhoid salmonellae.
• There is variation in the level of antibacterial activity of honey samples collected from different geographical locations.

Objectives:

• In vitro evaluation of honey for antibacterial activity by “Agar Well Diffusion Assay”
• Determination of minimum inhibitory concentration of honey by “Agar Dilution Assay”

Results:

Three beri honey samples (BE-8, BE-10, and BE-19) out of seven showed antibacterial activity against S. typhi at 50% (w/v) dilution. No honey sample produced zone of inhibition at 25% (w/v) dilution in sterile distilled water or in catalase solution except manuka honey which demonstrated 12.07+0.1 (mm) zone size against S. typhi.

The inhibition zone of tested organism was observed to increase with the increasing honey concentration. Four honey samples (BE-2, BE-5, BE-6 and BE-12) did not show any antibacterial activity at any concentration tested in this experiment. There was variation in the zone of inhibition of different honey samples. BH-19 also showed maximum zone of inhibition against S. typhi as compared to other honey samples. Regarding controls, diluent (sterile distilled water), catalase solution and simulated honey did not produce any zone of inhibition, whereas 6% phenol (w/v) exhibited 25.4 + 0.5 mm zone against S. typhi.

Conclusion:

• Natural honey is not linked with high osmolarity alone.
• Though Beri honey (BH-19) showed higher level of hydrogen peroxide related antibacterial activity.
• However, only Manuka honey displayed both type of antibacterial activity.

Future Work:

• Manuka honey, warrants further evaluation in mice typhoid model for its future therapeutic role in typhoid fever.
• Nevertheless, it is worthwhile to suggest oral use of honey supplementing other anti-typhoid drugs.