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Abstract
Aims: To evaluate the efficacy of commercially available honey-based products for the treatment of lower extremity wounds in a home care nursing setting. Methods: Twenty-two patients with lower extremity wounds (six male and 16 female, with an average age of 64 years), were retrospectively selected. Six patients had venous insufficiency, five had diabetes and the remaining patients had hypertension or rheumatoid arthritis as a major underlying aetiology. All the patients had non-healing wounds of at least four weeks' duration, in which they had been treated primarily with povidone iodine or fusidic acid. Fifty percent of the wounds were infected. All the wounds were treated with honey-based products, and only covered with a secondary dressing for protection or absorption of exudate. Results: Infected wounds were controlled within a few days.All the wounds progressed to healing without any adverse effects. Blood glucose levels remained unaffected and dressing changes were pain-free, with dressings being easy to apply. Conclusions: The results indicate that honey-based products are antibacterial, help to debride the wound and promote wound healing, and are safe and easy to use as well as being cost-effective. Conflict of interest: None.
... The observational study of Kegels was based on a sample of 22 patients presenting data obtained by administering local treatment with products based on honey available commercially [68]. All patients had injuries lasting at least four weeks unhealed. ...
... Emerging evidence from clinical studies suggests that honey is at least as effective as conventional treatments in healing wounds, particularly in very refractory cases such as in diabetics, the elderly, and extensively burned patients [47,48], but more clinical data are necessary for robust statistical appraisal [49]. Here, we have demonstrated the potency of natural honey as an antimicrobial wound dressing, and that multiple effects arise from a variety of active compounds, which not only allows active honey to be uniquely broad in spectrum, but also reduces the potential for resistant microbial populations to evolve. ...
... Honey use has been successfully reported in various wound care scenarios from burns to surgical to malignant wounds (Kegels, 2011;Saikaly and Khachemoune, 2017). Diabetic ulcers have also been among wound types most commonly treated (Candeias and Cardoso, 2007;Mohamed et al, 2013). ...
... Honey use has been successfully reported in various wound care scenarios from burns to surgical to malignant wounds (Kegels, 2011;Saikaly and Khachemoune, 2017). Diabetic ulcers have also been among wound types most commonly treated (Candeias and Cardoso, 2007;Mohamed et al, 2013). ...
... Honey use has been successfully reported in various wound care scenarios from burns to surgical to malignant wounds (Kegels, 2011;Saikaly and Khachemoune, 2017). Diabetic ulcers have also been among wound types most commonly treated (Candeias and Cardoso, 2007;Mohamed et al, 2013). ...
... 66 The glycoproteins may also serve as a potential candidate for developing a novel antibacterial drug. 50 Thomas et al. 125 Surgihoney Surgihoney RO Ô wound gel Dryden et al. 126 Dryden et al. 127 ...
Background:
The development of bacterial resistance to antibiotics has made it more difficult and expensive to treat infections. Honey is getting worldwide attention as a topical therapeutic agent for wound infections and potential future candidate for systemic infections.
Objectives:
The purpose of this review was to summarise different antibacterial bio-active compounds in honey, their synergistic interaction and their clinical implications in topical and systemic infections. In addition, contemporary testing methods for evaluating peroxide and non-peroxide antibacterial activity of honey were also critically appraised.
Design:
MEDLINE, EMBASE, Cochrane Library, Pub Med, reference lists and databases were used to review the literature.
Results:
Honey contains several unique antibacterial components. These components are believed to act on diverse bacterial targets, are broad spectrum, operate synergistically, prevent biofilm formation, and decrease production of virulence factors. Moreover, honey has the ability to block bacterial communication (quorum sensing), and therefore, it is unlikely that bacteria develop resistance against honey. Bacterial resistance against honey has not been documented so far. Unlike conventional antibiotics, honey only targets pathogenic bacteria without disturbing the growth of normal gastrointestinal flora when taken orally. It also contains prebiotics, probiotics, and zinc and enhances the growth of beneficial gut flora. The presence of such plethora of antibacterial properties in one product makes it a promising candidate not only in wound infections but also in systemic and particularly for gastrointestinal infections. Agar diffusion assay, being used for evaluating antibacterial activity of honey, is not the most appropriate and sensitive assay as it only detects non-peroxide activity when present at a higher level. Therefore, there is a need to develop more sensitive techniques that may be capable of detecting and evaluating different important components in honey as well as their synergistic interaction.
Conclusions:
Keeping in view the current guidelines for treatment of diarrhea, honey is considered one of the potential candidates for treatment of diarrhea because it contains a natural combination of probiotics, prebiotics, and zinc. Therefore, it would be worthwhile if such a combination is tested in RCTs for treatment of diarrhea.
... Emerging evidence from clinical studies suggests that honey is at least as effective as conventional antimicrobial therapy in healing wounds, particularly in very refractory cases, such as in individuals with diabetes, the elderly, and extensively burned patients, 25,26 but further clinical studies are necessary for robust statistical appraisal. 27 To date, more than 80 different microbial species associated with wound infections have been shown to 14 mm (40%) and 34 mm (34%) respectively. ...
There is renewed interest in the therapeutic use of honey, including use in the treatment of infected wounds and burn patients. In this study, we have assessed the antibacterial activity of Libyan floral Hannon honey on Escherichia coli and Staphylococcus aureus, both known to infect wounds. The effects of four concentrations (5%-30%) of honey were compared with that of four antibiotics (ampicillin, tetracycline, polymyxin, and ciprofloxacin) on the growth of these bacteria at early log, mid log, and late log phases. It has been shown that E. coli and S. aureus are to some degree susceptible during mid log phase compared with late log phase, demonstrated by their complete resistance to antibiotics. Chemostat culture was used to investigate the effect of honey on E. coli grown at a steady state with specific growth rates between 0.1 to 0.5 hour(-1). The rate of killing was distinctively clear during the two stages of growth monitored: there was a relatively moderate reduction at the slow growth phase (0.1 to 0.3 hour(-1)), while a dramatic reduction was obtained at the fast growth phase (0.3 to 0.5 hour(-1)), reaching a complete reduction at 0.5 hour(-1). These results complement data using the cup-cut technique. The antibacterial effect of honey was concentration and time dependent, the bactericidal effect was indeed observed at low concentrations, it demonstrates that the honey has more impact on slow growing bacteria than antibiotics have. We suggest that more reduction could be achieved at higher concentrations of honey. These results may have important clinical implications, such as for the management of wound and burn patients.
... Similar results were obtained in a recent retrospective study in which 22 patients with lower extremity ulcerations had delayed healing, in part attributed to application of povidone iodine or fusidic acid, and 50% of the wounds were infected. After treatment with honey-based products, all cases progressed to healing (Kegels, 2011).The use of honey may therefore have a place in VLU treatment (Jull, 2013). Antibiotics are not recommended because there is no evidence that the routine use of systemic antibiotics promotes VLU healing. ...
Chronic leg ulcers are a common medical problem among elderly patients and have a dramatic impact on quality of life as a result of pain, disability, and social isolation. Regardless of their cause, chronic leg ulcers remain difficult to treat. In recent years, there has been increasing interest in the use of honey as a therapeutic agent. Objective: To evaluate the efficacy of honey-based dressings in the treatment of chronic leg ulcers. Methods: Ten patients with chronic (mean duration 3.3 years) leg ulcers who had received non-honey based treatments with no improvement were included in this study. A honey gel dressing was applied twice a week as the only treatment. Results: Seven patients experienced complete healing of their leg ulcers. The remaining three patients showed a significant reduction in wound size, which was achieved in a mean time of 101 days (range 28-174 days). Conclusion: Honey-based dressings appear to be an efficient and easy to use treatment for leg ulcers.
... In the current study, the use of sub-inhibitory concentrations of honey has enabled us to examine the nature of honey inhibition, however these concentrations are well below those that would be used in a clinical situation, where whole honey is generally applied and complete and irreversible inhibition would be expected. Emerging evidence from clinical studies suggests that honey is at least as effective as conventional treatments in healing wounds, particularly in very refractory cases such as in diabetics, the elderly, and extensively burned patients [47,48], but more clinical data are necessary for robust statistical appraisal [49]. Here, we have demonstrated the potency of natural honey as an antimicrobial wound dressing, and that multiple effects arise from a variety of active compounds, which not only allows active honey to be uniquely broad in spectrum, but also reduces the potential for resistant microbial populations to evolve. ...
Treatment of chronic wounds is becoming increasingly difficult due to antibiotic resistance. Complex natural products with antimicrobial activity, such as honey, are now under the spotlight as alternative treatments to antibiotics. Several studies have shown honey to have broad-spectrum antibacterial activity at concentrations present in honey dressings, and resistance to honey has not been attainable in the laboratory. However not all honeys are the same and few studies have used honey that is well defined both in geographic and chemical terms. Here we have used a range of concentrations of clover honey and a suite of manuka and kanuka honeys from known geographical locations, and for which the floral source and concentration of methylglyoxal and hydrogen peroxide potential were defined, to determine their effect on growth and cellular morphology of four bacteria: Bacillus subtilis, Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa. While the general trend in effectiveness of growth inhibition was manuka>manuka-kanuka blend>kanuka>clover, the honeys had varying and diverse effects on the growth and cellular morphology of each bacterium, and each organism had a unique response profile to these honeys. P. aeruginosa showed a markedly different pattern of growth inhibition to the other three organisms when treated with sub-inhibitory concentrations of honey, being equally sensitive to all honeys, including clover, and the least sensitive to honey overall. While hydrogen peroxide potential contributed to the antibacterial activity of the manuka and kanuka honeys, it was never essential for complete growth inhibition. Cell morphology analysis also showed a varied and diverse set of responses to the honeys that included cell length changes, cell lysis, and alterations to DNA appearance. These changes are likely to reflect the different regulatory circuits of the organisms that are activated by the stress of honey treatment.
Honey is a well-known and historically important sweet food which possesses immense antimicrobial properties. Numerous varieties of honey are present in nature, and all of these honey varieties contain certain key ingredients, which confer upon them various antimicrobial properties. These antimicrobial key ingredients include polyphenolic compounds, hydrogen peroxide, methylglyoxal, and bee-defensin among several others. Honey is nowadays used extensively in modern medicine as potent antibiotic for the treatment of surface wounds and burns. It is also used in combination with other antibiotics to treat antibiotic resistance. As an antifungal agent, honey is used to treat the athlete’s foot (tinea pedis), jock itch (tinea cruris), and ringworm of face, scalp, nail, and hand (tinea corporus). In this chapter, we aim to provide a brief overview of various types of honey and their composition and describe extensively its various antimicrobial properties and how these properties are exploited in modern medicine as an alternative to popular therapeutics or in conjunction with it.
Objectives: To study efficacy of honey, as a dressing agent, in lower limb ulcers. comprises 53 patients of all the age groups with lower limb ulcer were admitted in the department of surgery and treated with local application of honey to size, reduction in slough and discharge, culture results, and decrease in pain. In 42 patients duration of symptoms is less than 1 month, 18 patients were suffering from end of 14 days 100% wounds became free of slough and discharge. At the end of seven days only 6 patients were having pain at the ulcer site. On day 14 there was no associated pain. admission, 44 patients undergone debridement, 47 patients progressed to healthy granulation tissue in 1 in two weeks. After 14 days ulcer of nine patients completely healed 50 patie ulcer after 1 month evaluation. The mean healing time estimated was 19.98 days. bacteria free within 14 days, honey removes offensive smells and has a desloughing action, stimulat tissue formation, stops further infections and the moist environment very suitable for wound recovery. Honey reduces the need for amputations.
Honey as a natural, unprocessed and easily digested food is a valuable nutritive product for children, athletes and convalescents. It has been used in ethno-medicine since the prehistoric times, and recently in the treatment of burns, healing wounds, chronic wounds, gastrointestinal disorders, asthma, skin ulcers, cancer, oncology, and as an antioxidant and antimicrobial agent. Propolis is prepared by bees of the Apis mellifera species, using resinous substances collected from various plants, and has been reported to possess pharmacological properties, such as antibiotic, anti-neoplastic, anti-inflammatory, anti-diarrheatic, antimicrobial, antiviral, antioxidant, hepatoprotective, cariostatic, antitumoral, anti-ulcerus, immunostimulator, antineurodegenerative, antituberculosis and anti-HIV-1 activity. The biological activity of these products is mainly attributed to phenolic compounds, such as flavonoids. In this context, the topical application of beehive products, particularly honey and propolis, has great potential in the treatment of several injuries and diseases, since it would improve patients' outcome without undesirable side effects. This chapter aims to present information from published studies regarding the beneficial effects of those products on a range of medical conditions and infected wounds.
Honey has been widely accepted as food and medicine by all generations, traditions, and civilizations, both ancient and modern. For at least 2700 years, honey has been used by humans to treat a variety of ailments through topical application, but only recently have the antiseptic and antimicrobial properties of honey been discovered. Honey has been reported to be effective in a number of human pathologies. Clinical studies have demonstrated that application of honey to severely infected cutaneous wounds rapidly clears infection from the wound and improves tissue healing. A large number of in vitro and limited clinical studies have confirmed the broad-spectrum antimicrobial (antibacterial, antifungal, antiviral, and antimycobacterial) properties of honey, which may be attributed to the acidity (low pH), osmotic effect, high sugar concentration, presence of bacteriostatic and bactericidal factors (hydrogen peroxide, antioxidants, lysozyme, polyphenols, phenolic acids, flavonoids, methylglyoxal, and bee peptides), and increase in cytokine release, and to immune modulating and anti-inflammatory properties of honey; the antimicrobial action involves several mechanisms. Despite a large amount of data confirming the antimicrobial activity of honey, there are no studies that support the systemic use of honey as an antibacterial agent.
Aims: To compare honey-based ointments and dressings for the treatment of paediatric partial-thickness burns and skin lesions with results from cases treated with conventional methods. Methods: Eight children (eight months-13 years) were included in the study when admitted to the emergency room (ER). Five had partial-thickness burns (2-35% total body surface area [TBSA]). The three others had necrotic ulcers, circular skin lesions and deep cervical trauma. After stabilising the patients in the ER, honey-based products were applied. Parents were given instructions on how to apply the honey ointment and dressings at home. Patients were followed up weekly on an out-patient basis. Similar cases treated with povidone iodine were collated from hospital archives for comparison. Results: All honey cases had complete epithelialisation by the end of the second week, without any adverse effects. The povidone iodine group needed on average three weeks for epithelialisation and had prolonged hospitalisation. The home care by the parents provided stress-free healing for both children and parents. Conclusions: The honey-based therapy indicates a fast (19 days vs 25-31 days), cost-effective and patient-friendlier treatment method compared to povidone iodine. Conflict-of-interest: None.
Honey is known, since antiquity, as an effective wound dressing. Emergence of resistant strains and the financial burden of modern dressings, have revived honey as cost-effective dressing particularly in developing countries. Its suitability for all stages of wound healing suggests its clinical effectiveness in diabetic foot wound infections. Thirty infected diabetic foot wounds were randomly selected from patients presenting to Surgery Department, Suez Canal University Hospital, Ismailia, Egypt. Honey dressing was applied to wounds for 3 months till healing, grafting or failure of treatment. Changes in grade and stage of wounds, using University of Texas Diabetic Wound Classification, as well as surface area were recorded weekly. Bacterial load was determined before and after honey dressing. Complete healing was significantly achieved in 43.3% of ulcers. Decrease in size and healthy granulation was significantly observed in another 43.3% of patients. Bacterial load of all ulcers was significantly reduced after the first week of honey dressing. Failure of treatment was observed in 6.7% of ulcers. This study proves that commercial clover honey is a clinical and cost-effective dressing for diabetic wound in developing countries. It is omnipresence and concordance with cultural beliefs makes it a typical environmentally based method for treating these conditions.
The aim of this study is to find out how honey influences the activities of the enzymes involved in energy metabolism during wound healing. Carbohydrate metabolism is the main source of energy for skin cells during wound healing. Since honey is full of sugars, and hence a rich source of energy, we have investigated the efficacy of honey on energy metabolism during wound healing in rats. A total number of 48 animals were used. From these, 24 animals were divided into two groups, control and experimental. Full thickness excision wounds were made on the back of rats. The control rats were left untreated. The experimental rats received 500 μL of honey topically, once daily, for 12 days. Six animals from each group were sacrificed on different time point intervals like 4, 8, and 12 days. The remaining 12 animals were used to evaluate the contraction and epithelialization. The activities of hexokinase, phosphofructokinase glyceraldehyde-3-phosphate dehydrogense, lactate dehydrogenase, and glucose-6-phosphate dehydrogenase were measured in the granulation tissue. A marked increase in the activities of all the glycolytic enzymes in the experimental wounds when compared to control suggests that honey could provide sufficient energy for cellular activity needed for the repair process.
The cytotoxic effects of antiseptics on pivotal cell types of the healing process have been well documented. The purpose of our investigation was to explore the ability of subcytotoxic levels of antiseptics to interfere with fibroblast function.
Cell proliferation assays were performed by culturing fibroblasts in the presence of commonly used antiseptics. Migration was evaluated using scratch assays in which monolayers were "wounded" and cellular movement was monitored by digital photography. Matrix metalloproteinase (MMP) release was analyzed by zymography.
H2O2 and povidone-iodine reduced both migration and proliferation of fibroblasts in a dose-dependent fashion. Treatment with silver-containing antiseptics and chlorhexidine exhibited reductions in proliferation at high concentrations, but enhanced growth at lower doses. Silver-containing compounds and chlorhexidine also proved to be the least detrimental to migration in these assays. metalloproteinase release from the cells was differently affected depending on the dosage and class of antiseptic applied.
When debridement of the wound bed is not sufficient to reduce bacterial loads, the application of broad-spectrum antiseptics maybe indicated. Our data would suggest that H2O2 and iodine are poor choices, potentially retarding the contribution of fibroblasts to the healing process. Silver sulfadiazine and chlorhexidine, at levels still proven to be bactericidal, had fewer detrimental effects on fibroblast activity in these assays. The silver-containing antiseptics may even increase the proliferative potential of these cells in culture.
Leg ulcers usually occur in older patients, a growing population for which increasing health care resources are required. Treatment is mainly provided in patients' homes; however, patients often receive poorly integrated services in multiple settings. We report the results of a prospective study of a community-based care strategy for leg ulcers.
International practice recommendations and guidelines were adapted to make a new clinical protocol. The new model, for a dedicated service staffed by specially trained registered nurses, established initial and ongoing assessment time frames and provided enhanced linkages to medical specialists. Data were collected for 1 year before and after implementation; outcome measures included 3-month healing rates, quality of life and resource usage.
Three-month healing rates more than doubled between the year before implementation (23% [18/78]) and the year afterward (56% [100/180]). The number of nursing visits per case declined, from a median of 37 to 25 (p = 0.041); the median supply cost per case was reduced from 1923 dollars to 406 dollars (p = 0.005).
Reorganization of care for people with leg ulcers was associated with improved healing and a more efficient use of nursing visits.
In recent years there has been a renewed interest in honey in wound management. There is a range of regulated wound care products that contain honey available on the Drug Tariff This article addresses key issues associated with the use of honey, outlining how it may be best used, in which wounds, and which clinical outcomes may be anticipated.
When antimicrobial agents are being evaluated prior to their introduction into clinical practice, advance publicity may interest potential users but acccess to that agent will normally be limited until licensed products are released and distributed. Honey is an ancient therapy that has recently been re-introduced into modern medicine. Medical grade honey (MGH) is being incorporated into sterile devices that are applied topically to wounds. Honey is universally recognized and it is readily accessible. Patients and practitioners may, therefore, consider using table honey from supermarkets as a cheap, readily available alternative to more expensive, regulated, honey-based wound care products. This study was designed to compare the antibacterial potency and microbial flora of 18 table honeys to a representative sample of Leptospermum honey (a MGH). Standardized tests of microbial content and in-vitro efficacy were conducted for each sample. Table honeys generally possessed lower antibacterial activity than the MGH and contained a wide range of microbial species, whereas MGH was sterile. The disadvantages of using non-sterile table, honeys in medical practice were reviewed. Results suggest the need for randomized clinical trials verifying the efficacy and/or safety of any form of honey used in topical wound care.
Clinicians have used numerous strategies to combat wound infections, including topical and systemic administration of antibiotics, and various antiseptic agents such as hypochlorite (bleach) and hydrogen peroxide have been placed on wounds to kill bacteria or inhibit their growth.¹ A commonly used antimicrobial agent is povidone-iodine (Betadine®*), a complex of iodine, the bactericidal component, with polyvinylpyrrolidone (povidone), a synthetic polymer.¹ The most common commercial form is a 10% solution in water yielding 1% available iodine.¹ Povidone-iodine is available as a surgical scrub or skin cleanser with a detergent base (0.75% available iodine) or in other forms.¹
Decisions regarding choice of wound treatment involve two basic consideriations: (1) how safe is the treatment, and (2) how effective is the treatment. The safety of a wound care treatment may be determined by whether the treatment retards the progress of the wound through the stages of healing (inflammatory, proliferative/reepithelializing, and remodeling).…
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has now been described globally, as a clinically significant pathogen, particularly associated with skin and soft tissue infections, including abscesses, cellulitis and furunculosis. The recent emergence of CA-MRSA combined with its predominant presentation associated with skin and soft tissue infection, the previous literature indicating honey as an effective treatment of healthcare-associated HA-MRSA-related wound infection, as well as honey's ease of topical application, make the current study timely and of interest to healthcare practitioners involved with wound management. Although previous studies have examined the antimicrobial activity of honey against HA-MRSA, such data are limited regarding the activity of honey against this emerging type of MRSA. CA-MRSA (n=6 isolates), was examined for its susceptibility to natural honey (n=3 honey produced from bees in Northern Ireland and one commercial French honey). Results demonstrated that all honey was able to reduce the cultural count of all CA-MRSA from approximately 10(6) colony-forming units (cfus) (mean = 6.46 log10 cfu/g) to none detectable within 24h of co-culture of separate CA-MRSA organisms individually with all four-honey types examined. Subsequent non-selective enrichment of honey demonstrated that inoculated honey remained positive for CA-MRSA until 72h postinoculation, after which point no culturable organisms could be detected. This study demonstrated that, in vitro, these natural products had an antimicrobial activity against the CA-MRSA organisms tested. Further studies are now required to demonstrate if this antimicrobial activity has any clinical application.
All open wounds healing by secondary intention are contaminated by bacteria and in chronic wounds this can progress through colonisation to invasive infection. Iodine products reduce bacterial load and are active against most species of micro-organisms, and certainly those encountered in chronic wound care. This review evaluates the use of iodine products in chronic wound care including povidone-iodine solutions and cadexomer iodine. Antiseptics containing iodine are relatively cheap, resistance is unknown and concerns about systemic toxicity are probably overstated. More widespread use of these agents as topical anti-microbials in chronic wound care should be considered to reduce the need for systemic antibiotics when colonisation has progressed to invasive infection with systemic signs.