Manuka Oil as an Alternative to Antibiotic Creams

New Zealand has a higher incidence of Staphylococcus aureus infections than anywhere else in the developed world, and there has been a significant increase in the number of infections over the past decade, with Māori and Pacific children particularly affected.

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Over usage of an antibiotic is likely to have contributed to this paradoxical increase in serious skin infections, according to results from a Health Research Council funded study. This revealed an increase in the prevalence of resistance in Staphylococcus aureus from 17% in 1999, to 28% in 2013. Dr Deborah Williamson, the clinical microbiologist who lead the study, made the statement in a recent press release that “The increase that we’ve seen in the incidence of serious skin infections in New Zealand children has happened at the same time as an increase in the dispensing of topical fusidic acid to treat skin infections”(1).

Fusidic acid is an antibiotic derived from the fungus Fusidium coccineum and was first released for clinical use in the 1960’s. A 2% fusidic acid cream is currently recommended as a first-line treatment for serious skin infections such as impetigo (school sores), infection of the hair follicles and boils. Most of these are due to the bacteria Staphylococcus aureus, including the notorious methicillin resistant Staphylococcus aureus (MRSA). Like all antibiotics, drug resistance can develop, and this is invariably at a rate proportionate to the extent of usage.

In a paper published in the New Zealand Medical Journal last December, Dr Williamson reviewed the history and usage of topical antimicrobials in New Zealand (2).

This painted a somewhat alarming picture, and the fusidic acid story is an all too familiar one. Another topical antimicrobial agent widely used throughout the 1990s, mupirocin (Bactroban©), was for many years made available to purchase ‘over-the-counter’ (OTC). This led to high levels of use, and subsequent high rates of resistance, and by 2000, approximately 14% of S. aureus isolates displayed high-level resistance to mupirocin(3) . From April, 2000, regulatory changes lead to mupirocin being restricted again to ‘prescription only’, and the resulting decreased usage lead to a fall in the prevalence of high-level mupirocin resistance in S. aureus from 14.2% in 2000, to 8.3% in 2014 (4).

New Zealand is not alone in having a high rate of bacterial resistance to topical antimicrobials, and resistance to antibiotics poses a major global threat, according to a 2014 report by the World Health Organisation(5). Resistance is happening in every region of the world, and unless some major developments take place soon, humankind could be heading towards a time when once again, antibiotics cannot be relied upon to protect against simple infections including those that are risk factors associated with surgery. Development of strategies to mitigate further increases in antimicrobial resistance to topical treatments, is urgently required(6, 7).

Key to this, should be effective wound management. This should combine mechanical-chemical procedures such as debridement, antiseptics, and antimicrobial supportive compresses to help remove the biofilm (an association of microbes and slime which adheres to the surface of the wound, delaying granulation tissue formation and migration of epithelial cells).

Limitation of the level of usage of drug-based antimicrobials, or using two or more of them together rather than alone, and avoidance of topical antibiotic use in common conditions such as acne, are other ways to help reduce the likelihood of resistance(8).

Plants contain a large number of diverse chemicals (phytochemicals) which they produce as defence tools to enable them to survive in their particular environment, and some of these have potent antibacterial activities which can help us fight a wide range of common skin infections.

manuka-2The New Zealand native Manuka (Leptospermum scoparium) is one of these, and the ability of certain forms of Manuka Honey to act as potent healing agents for wounds and ulcers, is becoming increasingly recognised(8). Many clinical trials have now shown manuka honey dressings to have unique healing properties in chronic leg ulcers and other stubborn skin infections, and synergistic antimicrobial activities with various antibiotics, have recently been reported(10,11).

Manuka’s medicinal properties extend way beyond those of the honey that bees manufacture from its pollen, however, and other parts and extracts of this wonderful plant, have therapeutic activities. Manuka essential oil has also been shown to exhibit powerful antimicrobial properties, particularly against Staphylococcus aureus and other Gram positive bacteria, yeasts such as Candida albicans and fungi such as Trichophyton rubrum, responsible for athletes foot. Manuka oils which are rich in beta triketone compounds, appear to have the strongest antimicrobial activity.

The extent to which topical application of an extract of this plant can rival drug-based treatments at overcoming sores, was highlighted by a research project by two students at Whangaroa College in Northland recently. After hearing about a fellow student’s spider bite that wouldn’t heal until it was treated with a native plant preparation, the two students, Cheyenne Rush and Georgia Mills, decided to investigate the antibacterial properties of manuka essential oil and an extract of another native plant kawakawa (Macropiper excelsum).

Their experiment, which they entitled Te Rongoa Māori , involved collecting and growing colonies of bacteria, spreading these onto agar plates and applying a quarter of a teaspoon of each product to be tested. The relative rates of decline of the bacteria was recorded daily for 14 days, for the manuka oil and kawakawa extract preparations, in addition to the well known antiseptics Savlon® and Betadine®, which were applied to other agar plates as controls.

The results showed that manuka oil was the most powerful antibacterial, followed by Savlon® then Betadine®, with the Kawakawa leaf extract the least effective. Cheyenne and Georgia’s project thus showed that a simple, traditional plant preparation can be more effective than prominent antiseptic products in fighting wound colonising bacteria. It also won them a top prize at the recent Top Energy Far North Science and Technology Fair, which involved more than 150 participants from 10 schools in upper Northland(12).

Refs:

  1. Media Release from the Health Research Council, Soaring rate of skin infections linked to resistance.NZ Doctor, 20 September 2016.
  2. Williamson D et al, A bug in the ointment: topical antimicrobial usage and resistance in New Zealand. NZ Med J 2015; 128(1426):103-9.
  3. Upton A et al, Mupirocin and Staphylococcus aureus: a recent paradign of emerging antibiotic resistance. J Antimicrob Chemother. 2003; 51:613-617.
  4. Heffernan H et al, Demographics, antimicrobial susceptibility and molecular epidemiology of Staphyloccosu aureus in New Zealand, 2014. https://surv.esr.cri.nz/PDF_surveillance/Antimicrobial/Staph/2014Saureussurveyreport.pdf
  5. Antimicrobial Resistance: Global report on surveillance. World Health Organisation, who.int.ISBN 978 92 4 156474 8; (http://www.bbc.com/news/health-27204988).
  6. Williamson D et al, Missing in action: an antimicrobial resistance strategy for New Zealand. NZ Med J, 2015; 128(1427):65-67.
  7. Williamson DA, Hefferman H. The changing landscape of antimicrobial resistance in New Zealand. NZ Med J 2014; 127(1403):41-54.
  8. Walsh TR, The Lancet Infectious Diseases, 2016; 16(3): 23-33
  9. Carter DA, Front Microbiol 2016; 7:569
  10. Muller P et al, PLoS One 2013; 8(2):e57679
  11. Liu M et al, Front Microbiol 2015; 5:779.
  12. https://ssl-www.stuff.co.nz/auckland/local-news/northland/83909327/Manuka-proves-best-bacteria-fighter

Respiratory Health in Singapore and Herbal Options

I recently spent a couple of days in Singapore, where herbal product needs are currently somewhat different to those in my New Zealand home. September in Singapore generally marks the start of the 3-4 month so-called ‘Haze season’, a period in which the air can be tainted for days on end, with a haziness due to smoke drift from fires in nearby Indonesia. The annual haze season started early this year, in late August, and on 26 August Singapore’s 24 hour Pollutant Standards Index (PSI) entered the ‘unhealthy’ range of above 100, while its 3-hour PSI reached 215(1). As with the haze last year, when the PSI reading at times exceeded 300, most people didn’t venture out without a face mask.

Agricultural fires are an annual occurrence across Sumatra and in parts of Kalimantan on Borneo, as corporations as well as small-scale farmers use slash-and-burn methods to clear vegetation for palm oil, pulp and paper plantations. As well as trees and forests, there is much peat land in these parts of Indonesia, and peat fires can burn and smoulder underground for several months.

Tsmog-over-the-city-1197986-639x359he haze contains particulate matter, fine particulate matter, heavy metals and poly aromatic hydrocarbons, and at its peak can measure hundreds of kilometres across. As well as affecting Singapore’s air quality and visibility, the air pollution can spread to Malaysia, southern Thailand and the Philippines. This can have a major impact on the health of the people and plants of these countries, and of course those of Indonesia itself.

Fine particulate matter especially, can enter deep into the lungs, causing respiratory illnesses and lung damage. Particulate matter pollution and its constituents also damages plant morphological structure, flowering, water content, growth and reproduction, and can have genotoxic impacts(2). Epidemiological studies have shown an increase in morbidity and mortality rates from chronic obstructive pulmonary disease after exposure to elevated levels of air pollution, and associations between lung cancer and cardiovascular diseases, are well established.

This situation leads to increased demand for herbal lung health products in Singapore by the local population seeking to do more than wear a mask to protect their lungs against the damaging effects of the haze. Herbs that gently support and encourage the natural expectoration process of the millions of cilia cells lining our bronchial trees, whose role is to remove excess mucus and potentially harmful substances such as particulate matter or unwanted allergens, are therefore useful. These include mucilaginous (polysaccharide hydrocolloid rich) and expectorant herbs such as Marshmallow (Althaea officinalis), Mullein (Verbascum Thapsus) and the NZ native Hoheria (Hoheria populnea). Other traditional lung herbs such as Elecampane (Inula helenium), White horehound (Marrubium vulgare) and Hyssop (Hyssopus officinalis), are also useful. For Singaporeans having to live in the seasonal haze, or citizens of cities in China and many other countries where air pollution is a regular feature of life, in order to help protect against reduced levels of cellular oxygenation and an increased risk of bronchial congestion, asthma, lung cancer and heart disease, these herbs can be useful daily tonics.

In addition, certain herbs have chemo-preventive or protective effects against cellular damage and carcinogenicity, that may be helpful when exposure to air pollution is unavoidable. Apart from its anti-inflammatory, antimicrobial and antioxidant properties, evidence suggests a possible protective effects against lung cancer by roots of the warming volatile oil rich Elecampane(3).  The root of the fiery Horseradish (Armoracia rusticana)(4), and aerial parts of Nasturtium (Tropaelum majus),(5-6) also both contain phytochemicals with established chemo-preventive effects against cancers, that seem to be well absorbed into the bloodstream when taken orally. These and expectorant actions make them specifically indicated to help prevent lung damage in those exposed to regular dangerous levels of airborne pollution, such as the annual Haze in Singapore.

untitled-design-17While considering this situation, I couldn’t help notice the presence of palm oil still in chocolate sold throughout Singapore, unlike certain other countries where it has been removed due to public concerns around the environmental impacts of a huge increase in palm oil plantations. Similarly the importation of palm kernels for use as a supplementary feed to dairy cows in New Zealand, needs a mention. Reflecting on this as well as the widespread use of palm oil in cheap vegetable oils and in many other food and non food consumer items found globally, there is clearly a need to address the underlying cause of such environmental pollution and factors responsible for poor human health, in a more integrative way. This burning of indigenous forests in Indonesia is related also to poverty as well as poor regulation by authorities there, but corporate greed, consumer usage and lack of awareness or concern for environmental and economic impacts, is contributory.

Until the slash and burn method of land clearing in Indonesia is stopped, health effects on the millions of people living in the region, and ongoing widespread loss of bio-diverse rich forests and destruction of the habitat of endangered species such as orangutans, tigers, elephants and rhinos, will continue.

 

Refs:

  1. “The haze is back across South East Asia”. BBC. Retrieved 26 August 2016.
  2. Rai PK, Ecotoxicol Environ Saf 2016; 129:120-136.
  3. Li Y et al, Z Naturforsch C 2012; 67(7-8):375-380.
  4. Weil MJ et al, J Agric Food Chem 2005; 53(5):1440-1444.
  5. Platz S et al, Anal Bioanal Chem 2013; 405(23):7427-7436.
  6. Pintao AM, Planta Med 1995; 61(3):233-236.