Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website https://jocmr.elmerjournals.com

Original Article

Volume 17, Number 8, August 2025, pages 445-459

The Elimination Effect of Medical-Grade Honey on Pseudomonas aeruginosa Biofilms: A Systematic Review and Meta-Analysis

Figures

↓  Figure 1. Flow diagram of the search process.
Figure 1.
↓  Figure 2. Funnel plot of included studies assessing the effect of medical-grade honey on P. aeruginosa biofilm.
Figure 2.
↓  Figure 3. Forest plot illustrating the effect of medical-grade honey on biofilm formation. Forest plots represent static biofilm models only.
↓  Figure 4. Forest plot illustrating the effect of medical-grade honey on established biofilm. Forest plots represent static biofilm models only.
Figure 4.
↓  Figure 5. Forest plot illustrating the effect of medical-grade honey subgroup division based on bacterial strains used in the study. Forest plots represent static biofilm models only.
Figure 5.
↓  Figure 6. Forest plot illustrating the effect of medical-grade honey on subgroup division based on control used in the study. Forest plots represent static biofilm models only. ABC: active biofilm control; Int.: intervention; SC: sterility control.
Figure 6.

Tables

↓  Table 1. Descriptive Summary of Included Studies
 
No. Study P. aeruginosa strain Medical-grade honey Honey concentrations tested CV assay Outcomes measured Key findings
ATCC: American Type Culture Collection; CV: crystal violet; MBEC: minimum biofilm eradication concentration; MBIC: minimal biofilm inhibitory concentration; MIC: minimum inhibitory concentration; NCTC: National Collection of Type Cultures; PBS: phosphat-buffered saline; UCBPP: University of California Berkeley Plant Pathology.
1 Camplin and Maddocks, 2014 [10] ATCC 9027, clinical isolate 867 Medihoney 0-80% w/v Stained with 0.25% w/v CV for 10 min. Two washes with PBS. Destaining with 7% acetic acid. MIC, MBEC, resistance development MIC: 15.3% to 25.6%. MBEC: 43.3% and 48.3%
2 Cooper et al, 2014 [27] Clinical isolate Medihoney 5-50% w/v Stained with 0.25% w/v CV for 15 min. Three washes with PBS. Destaining with 7% acetic acid. MIC50, MIC90, MBEC, biofilm structure MIC50: 16.8%, MBEC: 35.3%; ≥ 40% honey significantly alter biofilm structure and viability
3 Halstead et al, 2016 [28] ATCC 15692, NCTC 6749, clinical isolate Surgihoney RO, Medihoney, Manuka honey 1:3 to 1:6,144 dilution Stained with 1% w/v CV for 10 min. Two washes with PBS. Destaining with 70% ethanol. MBIC, biofilm biomass Honey dilution of 1:3 to 1:12 showed good results against P. aeruginosa biofilm (P < 0.05)
4 Lu et al, 2019 [13] ATCC 15692, UCBPP-PA14 Manuka, Medihoney, Clover honey 1-80% w/v Stained with 0.2% w/v CV for 60 min. Three washes with PBS. Destaining with 33% w/v acetic acid. MIC, MBIC, biofilm biomass, viability MBIC 16-32%; UCBPP-PA14 more susceptible than ATCC 15692; 64-80% honey eradicated biofilms
5 Maddocks et al, 2013 [29] ATCC 9027, clinical isolate 867 Medihoney 0-60% w/v Stained with 0.25% w/v CV for 10 min. Two washes with PBS. Destaining with 7% acetic acid. Biofilm biomass, adhesion, invasion Honey can reduce the amount of biofilm biomass to 33% (867) and 43% (ATCC 9027)
6 Morroni et al, 2018 [30] Clinical isolate Manuka honey, Kenya honey, Cuba honey 2-22% v/v Stained with 0.25% w/v CV for 10 min. Two washes with PBS. Destaining with 70% ethanol. Antimicrobial activity, biofilm biomass, Manuka honey minimal dilution for antimicrobial: 14%. Significant biomass reduction at ≥ 8%

 

↓  Table 2. Quality Assessment for Included Studies Using QUIN Tool
 
No. Criteria Microbiological relevance Camplin and Maddock, 2014 [10] Cooper et al, 2014 [23] Halstead et al, 2016 [24] Lu et al, 2019 [27] Maddocks et al, 2013 [25] Morroni et al, 2018. [26]
ANOVA: analysis of variance; OD: optical density; QUIN: Quality Assessment Tool for In Vitro Studies.
1 Clearly stated aims/objectives The objectives are clearly stated. The specific strain of P. aeruginosa and type of medical-grade honey is defined. 2 2 2 2 2 2
2 Detailed explanation of sample size calculation A sufficient number of replications had been performed for valid results. 1 1 1 1 1 1
3 Detailed explanation of sampling technique The studies describe how the biofilm was harvested, how it was diluted, how the samples were processed to accurately measure the outcome. 1 1 1 1 1 1
4 Details of comparison group The studies had defined the negative control and any positive controls. 2 2 2 2 2 2
5 Detailed explanation of methodology The methodology of studies includes specific microbiological details: bacterial strain, culture conditions, the method used to grow the biofilm, the concentration and form of honey used, the exposure time. 2 2 2 2 2 2
6 Operator details Operator details must meet standardized protocols. However, it is less critical for automated OD measurements. 0 0 0 0 0 0
7 Randomization The studies did not provide details regarding sequence generation and allocation concealment. 0 0 0 0 0 0
8 Method of measurement of outcome The method to measure outcome of biofilm biomass is crystal violet assay for optical density measurement. 2 2 2 2 2 2
9 Outcome assessor details The studies did not state number of outcome assessors and details regarding training and calibration of assessor(s). 0 0 0 0 0 0
10 Blinding No details regarding blinding of operator(s), outcome assessor(s), and statistician. 0 0 0 0 0 0
11 Statistical analysis The studies use valid statistical tests (e.g., t-test, ANOVA). 2 0 1 2 1 2
12 Presentation of results The studies provide summary statistics and visual representations. 2 2 2 2 2 2