Biofilm + MGO — the 2026 evidence roundup

Biofilm activity is the single most-asked question about medical-grade Manuka. The 2025–2026 literature continues to consolidate the picture: MGO disrupts both established and forming biofilms of Staphylococcus aureus (including MRSA) and Pseudomonas aeruginosa at clinically achievable concentrations.

What is now well-supported

• MGO penetrates EPS matrix and reaches viable cells in mature S. aureus biofilms.
• Activity is preserved in the presence of host catalase, which differentiates Manuka from peroxide-active honeys.
• No documented stable resistance development in vitro across serial passage studies — consistent with MGO's mechanism (covalent modification of multiple bacterial targets).

What is still missing

• Head-to-head RCTs against silver dressings on confirmed biofilm-burdened chronic wounds. The studies that exist remain small.
• Standardised in vitro biofilm models — different groups still use different MBEC assays, which makes meta-analysis hard.
• Long-term outcome data beyond 12 weeks on diabetic foot ulcers.

We track new papers in the Research Index as they appear.