On 14 April 2011, the Australian Wound Management Association published a journal article authored by The Wound Healing and Management Node Group answering the question – What is the best available evidence regarding the use of medical-grade honey for wound care? The findings from the report have been summarised below and indicate that Manuka honey is indeed an effective solution for a variety of wound care applications.

Type of honey

The antibacterial potency of medical-grade honey differs according to the plant source from which the nectar is derived. Honeys from different species can vary by as much as 100-fold in the potency of their antibacterial activity. The report found that the most widely used medical honeys are those sourced from New Zealand and Australian bees feeding on the Leptospermum scoparium bush (L. scoparium). These contain high levels of phytochemicals which is associated with antibacterial activity.

Applications

The use of medical-grade honey in wound care is supported by clinical research demonstrating effectiveness in the following applications:
  • as a topical antibacterial/anti-inflammatory treatment with broad application
  • as a debriding/desloughing agent
  • as a deodoriser of malodorous wounds
  • as a non-adherent agent that leaves newly granulating tissue intact when an outer dressing is removed
  • as an agent that maintains a moist wound healing environment
  • as an agent with low to negligible resistance properties, including documented effectiveness against antibioticresistant strains of in vitro and wound samples of Methicillin-resistant Staphylococcus aureus (MRSA); Pseudomonas aeruginosa; Escherichia coli and S. epidermidis

How honey works

  • Hydrogen peroxide, derived from the glucose acid in honey produces a broad spectrum antibacterial activity, clearing or protecting the wound from infection.
  • The literature suggests that the anti-inflammatory activity of honey results from the presence of high levels of antioxidants, thereby indicating that the removal of infection is in direct response to its use.
  • Honey dressings provide a moist environment and, thereby, encourage autolytic debridement of sloughy and necrotic wounds, allowing the area to contract, decrease bacterial burden and promote healing.
  • The anti-inflammatory properties of medical-grade honey contribute to a reduction in oedema and exudate as well as a reduction or prevention of hypertrophic.
  • Following debridement of the wound, honey promotes the formation of granulation and epithelial tissue, encouraging the creation of collagen and angiogenesis.
  • Wound malodour, which causes distress to patients and relatives, may be reduced through honey’s bactericidal effects on the anaerobic bacteria causing the wound odour.

Treatment

  • Burns: Honey may be used to improve healing in mild to moderate superficial and partial-thickness burns
  • Skin Graft Fixation: An observational study confirmed that medical-grade honey is beneficial in skin graft fixation. The honey prevented graft loss through infection and mobilisation, diminished the need for graft saturation and was an effective, inexpensive and easy to apply agent.
  • Venous Ulcers: Manuka honey may be considered by clinicians for use in sloughy venous ulcers as it has a beneficial therapeutic effect

Exudate

Heavily exudating wounds require more regular dressing changes as the exudate dilutes the antibacterial effectiveness of the medical-grade honey. The minimum inhibitory concentration, or MIC, is the lowest concentration to which honey can be diluted by wound exudate (or by other factors) and still prevent bacterial growth. A literature review reported the MIC of Leptospermum honey against a range of bacteria:
  • 2% to 3% for Staphylococcus aureus
  • 3.3% to 4% for coagulase-negative staphylococci
  • 5.5% to 9% for Pseudomonas species
  • 2.7% to 3% for MRSA
  • 3.8% to 5% for vancomycin-resistant enterococci

Comparisons

Silver Sulphadiazine (SSD) Cream
The study found that honey when compared with silver sulphadiazine (SSD) cream was found to be significantly more effective in the treatment of superficial and partial-thickness burns
Hydrogel Therapy
A randomized controlled trial that compared medical-grade Manuka honey with standard hydrogel therapy reported that significantly more venous leg ulcers healed at 12 weeks when treated with medical-grade Manuka honey than those treated with standard hydrogel therapy (44% versus 33% respectively). At four weeks, a reduction in wound slough from baseline was also reported; an overall reduction of 56% for wounds treated with honey and 35% for wounds treated with standard hydrogel therapy was reported.

Bacterial Resistance

Studies have shown that the potential for bacteria to develop resistance to Manuka honey is low. A temporary resistance to Manuka honey was observed under long-term stepwise resistance testing but no lasting mutations were detected.

Risks

The report found only two possible risks of using manuka honey:

  • Maceration: Due to honey’s osmotic effects (drawing fluid from surrounding tissues producing a moist wound interface) increased levels of exudate may increase the risk of maceration of the surrounding skin; ongoing wound assessment practices are of importance to prevent or minimise any such adverse events.
  • Contraindiction: Honey dressings should be avoided in patients with a known history of allergy to either honey or bee venom

Find out more

View the full report, The use of medical-grade honey in wound care, by The Wound Healing and Management Node Group, published in The Australian Wound Management Association

July 4th, 2016|