Randomized controlled trial of honey versus mupirocin to decolonize patients with nasal colonization of meticillin-resistant Staphylococcus aureus

T.T. Poovelikunnel, G. Gethin, D. Solanki, E. McFadden, M. Codd, H. Humphreys

To describe the learning experience from a randomised controlled trial (RCT) comparing the efficacy of medical-grade honey (MGH) with mupirocin 2% for the eradication of nasal methicillin-resistant Staphylococcus aureus (MRSA). Patients colonised in the nose with MRSA and age ≥18 years were recruited. Participants received either one or two courses of MGH or mupirocin 2%, three times per day for five consecutive days. The proportion of patients who were decolonised after one or two courses of treatment was not significantly different between MGH (18/42; 42.8%; 95% CI: 27.7% - 59.0%), and mupirocin 2% (25/44; 56.8%; 95% CI: 41.0% - 71.7%). Non-nasal MRSA colonisation was significantly associated with persistent nasal colonisation, (p=0.003, OR, 5.186, 95% CI: 1.736 - 15.489). The rate of new acquisition of mupirocin resistance was 9.75%. Although not significant, a decolonisation rate of 42.8% for MGH was impressive. In the absence of other effective agents, MGH has a potentially clinically important role. Our findings suggest this strategy, which has the potential to combat antimicrobial resistance, should be assessed in similar but larger studies. Studies of natural agents where there is no commercial patent and which are, therefore, unlikely to be funded by industry, need to be adequately funded by national and or international agencies so that well designed multi-centre RCTs can be carried out which may provide alternatives to antibiotics where resistance is a continuing challenge. The lessons learned may help guide future studies in determining realistic recruitment potential.