The majority of studies to date have demonstrated the antimicrobial activity of honey against a range of microbial
strains including clinical isolates, using in vitro antimicrobial assays. Fewer studies have demonstrated the antimicrobial activity of honey in vivo; studies carried out so far have mainly investigated the antimicrobial activity of honey in relation to wound infections. In the 1st decade of the 21st century, several case studies involving wound patients produced optimistic findings. A brief report by Cooper et al described how treatment of a S.aureus-infected, recalcitrant surgical wound in a 38-year-old female with Manuka honey-impregnated dressings and oral coamoxiclav resulted in significant healing of the wound and bacterial clearance 7 days after commencing the treatment. The wound was 3 years old, and had failed to respond to other conventional
wound treatments and antibiotics during the 3-year period prior to commencing the honey/antibiotic combination
therapy. Natarajan et al treated an MRSA-infected legulcer of an immunosuppressed patient with topical application of Manuka honey; consequently, MRSA was eradicated and the wound successfully healed. Chambers reported bacterial clearance in three cases of MRSA-infected leg ulcers following treatment with topical Manuka honey, while Visavadia et al reported that Manuka honey, based on clinical experience, was now one of their first-line treatments for infected wounds at the Maxillofacial Unit at the Royal Surrey County Hospital, Guildford, Surrey.