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More on honey and wounds

 

Clinical bottom line

Two more randomised trials with 1000 additional patients confirm results of a systematic review, that honey is an effective treatment for burn wounds.


A systematic review examined seven randomised trials of the use of honey as a dressing for burns or wounds. The conclusion was that honey was effective. A correspondent from India has sent two further randomised trials, one missed by the original search (probably because the journal was not in MEDLINE) and the other published subsequently. Bandolier would be grateful if correspondents sent information on any other studies.

Study 1

M Subrahmanyam. Honey dressing for burns - an appraisal. Annals of Burns and Fire Disasters 1996 IX: 33-35.

Subjects were 900 patients with partial-thickness burns in less than 40% body surface area. Inclusion criteria were partial-thickness burns judged by appearance, presence of blisters of desquemated skin, capillary return, and sensitivity.

Randomisation after initial treatment was to a honey dressing (n=450) or a conventional dressing (n=450). For the honey dressing 15-30 mL of pure, unprocessed honey was applied to the surface of the burn, covered with sterile gauze and bandaged. Honey was applied on alternate days until the wound healed. For the conventional dressing wounds were covered with vaseline impregnated gauze, OpSite or Soframycin (90 patients each). In 90 more patients the wounds were exposed with sterile linen changed at frequent intervals, and in 90 more patients sterile gauze was applied and the wound bandaged.

The study was not blinded, and there appeared to be no withdrawals or dropouts.

Results

The honey and control groups were well matched at baseline.

Wound healing in honey-treated patients occurred in 10 days in 275/450, and in 15 days in 350/450. The mean time for wound healing was 9 days. In conventionally-treated patients wounds healed in 12-28 days, with a mean time to wound healing of 13.5 days.

Infected wounds occurred in 25/450 (5.5%) of patients treated with honey, and 52/450 (12%) of those with conventional treatment.

Minor scars occurred in 18/450 (6.2%) with honey and 87/450 (20%) with conventional treatment.

Study 2

M Subrahmanyam et al. Effect of topical application of honey on burn wound healing. Annals of Burns and Fire Disasters 2001 XIV: 143-145.

Subjects were 100 patients with burns involving less than 40% of body surface area treated with six hours of the burn.

Randomisation after initial treatment was to honey dressing (n=50) or to silver sulphadiazine impregnated dressing (n=50). Dressings were replaced every two days until healing. Bacterial cultures were made from swabs on admission and weekly or until the wounds healed.

The study was not blinded, and there appeared to be no withdrawals or dropouts.

Results

The honey and control groups were well matched at baseline.

Healing was faster with honey, with a mean time of 15 days as against 17 days with silver sulphadiazine (Table 1),

Table 1: Healing rates with honey or silver sulphadiazine

Cumulative number (%) healed

Treatment

Day 7

Day 14

Day 21

Honey (n=50)

8 (16%)

45 (90%)

50 (100%)

Silver sulphadiazine (n=50)

4 (8%)

26 (52%)

50 (100%)

In the honey group, 44/50 patients had positive swab cultures on admission. After one week of honey treatment, 40/44 (90%) were sterile. In the silver sulphadiazine group, 42/50 had positive swabs on admission, and all showed persistent infection after one week.

Hospital stay averaged 22 days with honey treatment and 32 days with silver sulphadiazine. Slit-thickness grafting was needed in one patient treated with honey and 11 with silver sulphadiazine.

Comment

These two trials add a remarkable further 1,000 patients to those in the systematic review . The two trials were very positive for use of honey for burn wounds compared with conventional treatment.