Bacterial infection is fast becoming resistant to treatment with antibiotics - faster, that is, than new drugs can be developed. This makes it harder to treat infection caused by injury, surgery or even a suppressed immune system as a result of chemotherapy cancer treatment. Antimicrobial Resistance (AMR) is caused by over-prescription and improper use of antibiotics by humans and in animals, but bacteria also develop resistance naturally as they evolve. However, with some help from bioengineers, nature could be about to provide the sweetest of solutions.

Honey has been used for centuries to treat wounds. Its low pH and moisture content combine with high levels of sugar to inhibit bacterial growth. When honey becomes diluted in a wound, hydrogen peroxide is produced, which in turn releases low concentrations of reactive oxygen that kills microbes and promotes healing. Additionally, bacterial cell membranes are disrupted by the antimicrobial peptide bee defensin-1 secreted into honey by bees. It is also thought that methylglyoxal (MGO) in honey fights tissue damage caused by infection and stimulates cell repair.

Honey sourced naturally from bees that pollinate manuka bushes, native to Australia and New Zealand, is known for having high concentrations of MGO. Manuka has received official approval for use as a medicine and because, unlike table honey, it has proven antimicrobial activity. Revamil, which is medical-grade honey, is one alternative that is much lower in MGO but could have more consistent therapeutic properties because it is produced under controlled conditions.

A new “bioengineered” medical-grade honey could be about to switch things up. SHRO (Surgihoney Reactive Oxygen) is biologically modified honey that produces a sustained release of reactive oxygen. In trials SHRO has shown a broad-spectrum antibiotic effect against organisms, including gram-positive bacteria Staphylococcus aureus (MRSA) and gram-negative bacteria Enterobacteriaceae (E. coli), but also against multidrug-resistant bacteria. Trials suggest the engineered version of honey is comparable with chemical antiseptics in its antimicrobial activity. Just a smear of honey prevents the build-up of bacteria-laden biofilm on catheters and indwelling medical devices significantly reducing infection risk.

Concern over a sharp decline in antibiotic effectiveness has renewed interest in alternative approaches to healing infection that may also help reduce antibiotic use. A discovery void has meant no introduction of new antibiotics for more than 30 years. During this time, annual excess deaths directly due to antibiotic resistance have continued to climb despite steady improvements in overall mortality.

Although new antibiotic drugs are in the pipeline, they remain some way off - a bitter hiatus that could see mortality increases outstrip longevity improvements. A bioengineered medical-grade version of honey, which could help when the drugs don’t work, could be sweet news for global public health.