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Update on honey therapy: 2007

Clinical bottom line

The amount of additional information on the use of honey therapy is limited. Studies continue to show honey to be useful in treating infected wounds.


Background

Honey has been shown to be useful for treating infected wounds and burns (for previous evidence see here, here and here), and while the amount of evidence has occasionally been large, the quality has been limited. Overall, though, there is a consistent story that honey is effective at treating infected wounds or burns, and is at least as effective compared with conventional therapies. Whether honey has a role in any other way is questionable because of lack of any good evidence.

Honey and wounds

Additional studies have appeared on PubMed in the last few years, randomised trials from Africa (Nigeria, Soputh Africa, Malawi) and a case series from Germany. All were small.

The Nigerian trial [1] involved 32 consecutive children without HIV or septicaemia with 43 clinically diagnosed pyomyositis abscesses. After incision and drainage, children were given 21-day courses of antibiotics, and the wounds left to close spontaneously. Wounds were randomised to twice daily EUSOL (Edinburgh University solution of lime) dressings, or dressings soaked in crude undiluted local honey.

The course of healing was faster with honey than with EUSOL, and by day 21 20/23 honey-treated wounds had complete epithelialisation, compared with 11/20 treated with EUSOL. The median hospital stay was 14 days with honey and 22 days with EUSOL. Secondary wound closure was not needed with either treatment.

A short case series of oncology patients from Germany [2] documents successful treatment of infected wounds with honey, mostly in association with antibiotics.

In a randomised trial of new shallow wounds and abrasions [3] honey was compared with a conventional hydrogel wound care product in 82 gold miners. In both cases healing times were similar with both, but the average cost per patient was lower with honey, which was a local honey. Similar results were also seen for honey compared with a paraffin impregnated dressing for treatment following toenail avulsion in a randomised, double blind trial involving 100 patients [4].

Healing with honey appeared to be better than sugar in an open comparison of 40 patients in Malawi [5].

Catheters

Because honey can cure infected wounds, it makes some sense to try using honey to prevent infections. Implanted catheters used in the longer term can become infected. A randomised trial [6] compared honey with standard care (calcium mupirocin ointments) as well as standard exit site care and iodine disinfection in 101 patients with tunnelled, cuffed, central venous catheters for haemodialysis. The definition of catheter-related infection was defined according to standard criteria. In the case of suspected catheter-associated bacteraemia, the catheter was removed and the tip sent for culture.

Catheter associated infection occurred at the same rate in both groups (6/51 honey; 5/50 muprocin), at rates of 0.97 and 0.85 per 1000 catheter days, respectively. Median costs for the life of a catheter were the same in both cases.

Cutaneous leishmaniasis

A randomised trial from Iran has now evaluated honey in treating ulcers caused by cutaneous leishmaniasis [7]. Patients received either weekly intralesional injections of glucantime alone, or additionally with twice-daily use of firmly applied honey soaked gauze, up to a maximum of six weeks. There was no overall benefit of honey dressings, and perhaps a small decline in the proportion of patients with complete healing.

Comment

The last two or three years have not brought what we might think of as the "killer" paper, the study that unequivocally demonstrates benefits to patients (in terms of good results in patients with particular problems) or to health services (perhaps with lower costs, or intangible benefits like tackling antibiotic resistant organisms). That being said, the general positive result of honey being effective in infected wounds seems to be maintained. The biggest problem is that the quality of study reporting remains generally poor, and numbers tends to be small, limiting the importance we can put on any findings.

References

  1. JA Okeniyi et al. Comparison of incised abscess wounds with honey and EUSOL dressing. Journal of Alternative and Complementary Medicine 2005 11: 511-513.
  2. A Simon et al. Wound care with antibacterial honey (Medihoney) in pediatric haematology-oncology. Supportive Care in Cancer 2006 14: 91-97.
  3. R Ingle et al. Wound healing with honey - a randomised controlled trial. South African Medical Journal 2006 96: 831-835.
  4. CD McIntosh, CE Thompson. Honey dressing versus paraffin tulle gras following toenail surgery. Journal of Wound Care 2006 15: 133-136.
  5. ANG Mphande et al. Effects of honey and sugar dressings on wound healing. Journal of Wound Care 2007 16: 317-320.
  6. DW Johnstone et al. Randomized, controlled trial of topical exit-site application of honey (Medihoney) versus mupirocin for the prevention of catheter-associated infections in haemodialysis patients. Journal of the American Association of Nephrology 2005 16: 1456-1462.
  7. MA Nilforoushzadeh et al. Effect of topical honey application along with intralesional injection of glucantime in the treatment of cutaneous leishmaniasis. BMC Complementary and Alternative Medicine 2007, 7:13.