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

J Hosp Infect. 2018 Feb;98(2):141-148. doi: 10.1016/j.jhin.2017.10.016. Epub 2017 Oct 26.


Background: Mupirocin is used specifically for the eradication of nasal meticillin-resistant Staphylococcus aureus (MRSA), but increasing mupirocin resistance restricts its repeated use. The antibacterial effects of manuka honey have been established in vitro; antibacterial activity of other honeys has also been reported.

Aim: To describe the learning experience from a randomized controlled trial (RCT) comparing the efficacy of medical-grade honey (MGH) with mupirocin 2% for the eradication of nasal MRSA.

Methods: Patients colonized 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.

Findings: The proportion of patients who were decolonized after one or two courses of treatment was not significantly different between MGH [18/42; 42.8%; 95% confidence interval (CI): 27.7-59.0] and mupirocin 2% (25/44; 56.8%; 95% CI: 41.0-71.7). Non-nasal MRSA colonization was significantly associated with persistent nasal colonization (odds ratio: 5.186; 95% CI: 1.736-5.489; P = 0.003). The rate of new acquisition of mupirocin resistance was 9.75%.

Conclusion: Although not significant, a decolonization rate of 42.8% for MGH was impressive. Our findings suggest that this strategy, which has the potential to combat antimicrobial resistance, should be assessed in similar but larger studies.

Keywords: Antimicrobial resistance; Decolonization; Medical-grade honey; Meticillin-resistant Staphylococcus aureus.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Topical
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage*
  • Biological Products / administration & dosage*
  • Carrier State / drug therapy*
  • Carrier State / microbiology
  • Female
  • Honey*
  • Humans
  • Male
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification*
  • Middle Aged
  • Mupirocin / administration & dosage*
  • Staphylococcal Infections / drug therapy*
  • Staphylococcal Infections / microbiology
  • Treatment Outcome
  • Young Adult


  • Anti-Bacterial Agents
  • Biological Products
  • Mupirocin