Int J Antimicrob Agents. 2017 Feb 28. pii: S0924-8579(17)30063-8. doi:
Clostridium difficile associated disease is an increasingly common health problem. C. difficile is a causative agent of antibiotic associated pseudomembranous colitis, antibiotic associated colitis and antibiotic associated diarrhea1. C. difficile overgrowth usually occurs during antibiotic therapy, as the normal gastrointestinal flora is disrupted. Discontinuation of antibiotics does not lead to symptomatic improvement and new strains of the pathogen have a substantial failure rate after therapy cessation2.
Our research team3, as well as other clinical researchers4 have performed in vitro studies demonstrating that unprocessed honeys have antibacterial activity against a range of pathogens, including C. difficile. Although the therapeutic mechanism of honey has not yet been fully elucidated, an antibacterial effect has been attributed to osmolarity, hydrogen peroxide generation and unidentified additional phytochemical components5. Furthermore, as well as antibacterial activity, honey has been shown to have an anti-inflammatory function5. We describe, to the best of our knowledge the first case of therapy resistant C. difficile infection with complete resolution of symptoms following bowel lavage with diluted honey.
A 71-year old woman was seen at the Gastroenterology and Hepatology outpatient clinic presenting with frequent watery stools and faecal incontinence. The results of laboratory investigations and colonoscopy showed a C. difficile infection. The patient was initially treated with vancomycin. However, diarrhea persisted during treatment and concurrent therapy with metronidazole resulted in adverse side-effects. Consequently, the patient was treated with fidaxomicin and following ten days of antibiotic therapy the patient experienced a decrease in symptoms. However, 1 day after cessation of therapy, the patient exhibited a relapse of watery stools. The relapsing nature of the infection dictated a continuous antibiotic therapy over months with relapse of diarrhea immediately after cessation of fidaxomicin. Treatment with faecal transplantation was discussed, however the patient refused this approach in therapy.
Alternatively, the patient was offered a therapeutic intervention with commercially available Manuka honey (UMF 26+) and received a 400ml endoscopic honey lavage with a solution of 8% honey, administered throughout the entire colon. Following initial lavage treatment the patient remained symptom free for 5 days before frequent watery stools reoccurred. A second lavage of the colon and terminal ileum was administered with 15% honey solution, after which the patient experienced complete cessation of watery stools and has remained symptom free for 6 months. Further stool analysis following treatment failed to identify C. difficile following the procedure.
This case report demonstrates the possible therapeutic value of honey lavage as a treatment for therapy resistant C. difficile infection, indicating the need for more clinical research in this matter.
Sophie L. Giles, M.D.
Robert J.F. Laheij, M.D. Ph.D
Department of Gastroenterology and Hepatology.
Elisabeth-TweeSteden Hospital Tilburg.
- Larson HE, Price AB, Honour P, Borriello SP. Clostridium Difficile and the aetiology of Pseudomembranous Colitis. Lancet 1978; 311(8073): 1063-1066
- Kelly CP, LaMont JT. Clostridium difficile-more difficult than ever. N Engl J Med 2008; 359(18): 1932-1940
- Laheij R, Ingham C, van Oijen MGH, Sbeeberger P. The antibacterial activity of honey against a hypervirulent clostridium difficile strain. Gut 2009; 58 (Suppl II)
- Hammond EM, Donkor ES. Antibacterial effect of Manuka honey on Clostridium difficile. BMC Research Notes 2013; 6: 188-192
- Toarmina PJ, Niemira BA, Beuchat LR. Inhibitory activity of honey against foodborne pathogens as influenced by the presence of hydrogen peroxide and level of antioxidant power. Int J Food Microbiol 2001; 69: 217-225