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Honey as a wound dressing

Clinical bottom line

Honey has been used to treat infected wounds and burns. There is a logic to this because it is hyperosmolar, and because it contains specific antimicrobial substances. Trials have been randomised, but usually of low reporting quality otherwise, and predominantly from a single researcher. There is, though, a large treatment effect with an NNT of 2.6 (2.1 to 3.4) to produce one patient with a healed burn compared with any other treatment.


Reference

OA Moore, RA Moore, LA Smith, F Campbell, K Seers, HJ McQuay. Systematic review of the use of honey as a wound dressing. BMC Complementary and Alternative Medicine 2001 1: 2. ( http://www.biomedcentral.com/1472-6882/1/2 )

[There is an update on honey and burns, with information on two additional RCTs with 1,000 more patients. Click here for details]

Review

Searching used a variety of electronic databases up to about August 2000. Inclusion criteria were randomised trials comparing honey with a control group in adults or children with burns or wounds, infected or sterile. For inclusion a study had to have at least 10 individuals per treatment group, and clinical or microbiological outcomes. Studies on animals, or laboratory experiments involving assessment of antimicrobial properties of honey were excluded.

There were seven randomised trials, six performed in India by the same researcher, and one performed in the United Arab Emirates. Two of the studies involved superficial burns, three partial thickness burns, one moderate to severe burns that included full thickness injury, and one infected postoperative wounds. All the controls were active comparisons, though these included potato peelings and amniotic membrane as well as conventional treatments. The main outcomes were the effects of honey and controls on healing time and infection rate, though antibiotic use and hospital stay were also noted in some studies. None of the studies was blinded and only one designated a primary outcome. The quality score for each trial was 1 out of a possible range of 1-5, and validity scores ranged between 5 and 10 out of range of 0 to 16.

Results

A single study in infected postoperative wounds compared honey with antiseptics in addition to systemic antibiotics after culture and sensitivity. For all outcomes honey was significantly better, with much shorter times for healing, eradication of infection, use of antibiotics and hospital stay (supplementary material). The proportion of wounds healed without dehiscence or resuturing was 22/26 (85%) for honey compared with 12/24 (50%) with antiseptic.

A single study of moderate or severe burns compared honey with tangential excision. For all outcomes tangential excision followed by grafting by six days post burn was significantly better than initial honey treatment followed by grafting where necessary. Half of all the patients had full thickness burns, and half of those treated with honey eventually needed skin grafts.

Five studies were conducted in patients with partial thickness or superficial burns involving less than 40% of the body surface. Comparators were polyurethane film, amniotic membrane, potato peel and silver sulphadiazine . For some or all outcomes honey was superior to all these treatments. Time for healing was significantly shorter for honey than all these treatments.

Treatment with honey produced significantly more healing at seven days. At seven days 58% of patients were healed with honey, and 19% with other treatments (Figure 1). The number needed to treat for seven days with honey to produce one patient with a healed burn was 2.6 (2.1 to 3.4) compared with any other treatment. By 21 days 99% of patients were healed with honey, and 75% with other treatments. The number needed to treat for 21 days with honey to produce one patient with a healed burn was 4.2 (3.3 to 6.0) compared with any other treatment.

Figure 1: Percent of patients healed with honey or control treatment at seven days

Comment

This is an interesting topic with some intriguing background science. Clearly the studies done to date are open to bias because or their poor reporting quality, but the effects of honey were large in different conditions and with different comparators, one of which was wholly conventional. Interesting too are the outcomes chosen, and the timing for healing.

An area worth keeping an eye on, especially with Cochrane reviews on their way that might give a better insight into what outcomes are most important.