In vitro synergy between manuka honey and amikacin against Mycobacterium abscessus complex shows potential for nebulisation therapy

Victoria Nolan, James Harrison, Jonathan A.G. Cox*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Mycobacterium abscessusis an opportunistic human pathogen of increasing concern, due to its ability to cause aggressive pulmonary infections (especially in cystic fibrosis patients), as well as skin and soft tissue infections. M. abscessus is intrinsically drug resistant and treatment regimens are lengthy, consisting of multiple antibiotics with severe side effects and poor patient success rates. New and novel strategies are urgently required to combat these infections. One such strategy thus far overlooked for mycobacteria is manuka honey. For millennia manuka honey has been shown to have wide ranging medicinal properties, which have more recently been identified for its broad spectrum of antimicrobial activity. Here we demonstrate that manuka honey can be used to inhibit M. abscessus and a variety of drug resistant clinical isolates in vitro. We also demonstrate using a microbroth dilution checkerboard assay that manuka honey works synergistically with amikacin, which is one of the current front line antibiotics used for treatment of M. abscessus infections. This was further validated using an in vitro inhalation model, where we showed that with the addition of manuka honey, the amikacin dosage can be lowered whilst increasing its efficacy. These findings demonstrate the utility of manuka honey for incorporation into nebulised antibiotic treatment for respiratory infections, in particular M. abscessus. These results pave the way for a change of strategy for M. abscessus management, offering new therapeutic options for this deadly infection.
Original languageEnglish
Article number001237
Number of pages9
Issue number9
Publication statusPublished - 7 Sept 2022

Bibliographical note

© 2022 The Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution License. This article was made open access via a Publish and Read agreement between
the Microbiology Society and the corresponding author’s institution.

Funding Information:

J.A.G.C. is grateful to the Academy of Medical Sciences, Global Challenges Research Fund, Birmingham Women’s and Children’s Hospital Charity Research Foundation and Give A Child Health Fund for their continued support of the Mycobacterial Research Group at Aston University. This research was funded by the Academy of Medical Sciences/the British Heart Foundation/the Government Department of Business, Energy and Industrial Strategy/Global Challenges Research Fund/the Wellcome Trust Springboard Award [SBF003\1088]. VCN is supported with a PhD Studentship jointly funded by Give A Child Health Fund and Aston University. JH is supported by a Venture Innovation Award from the Cystic Fibrosis Trust, UK, VIA Award Number: 098.


  • Manuka honey
  • Mycobacterium abscessus
  • Synergy
  • Antimicrobial
  • Nebulised therapy
  • Amikacin


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