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Role of honey as adjuvant therapy in patients with sore throat

Authors:
  • Maharishi Markandeshwar Medical college and Hospital Solan
  • Maharishi Markandeshwar medical college kumarhatti solan Himachal pardesh India

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Background: Honey is a natural product which has been used since ages for curing of various ailments. Aims and Objectives: To evaluate the effect of honey for control of infection and inflammation in patients with sore throat. Materials and Methods: A total of 200 patients with sore throat were taken up for the study. 100 patients, in the study group, were given one tablespoon of honey twice a day along with anti-inflammatory drugs, antibiotics, and antiseptic gargles. Remaining 100 patients in control group were given other same medications without honey. Patients were evaluated after 5, 10 and 15 days for throat congestion, fever, pain, patient satisfaction, and other criteria. Results: There was faster relief of signs and symptoms of sore throat in the study group as compared to control group. There was greater patient satisfaction in the study group. Conclusion: Honey is effective in faster recovery of signs and symptoms of sore throat having antibacterial and anti-inflammatory properties without causing any side effects.
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1 National Journal of Physiology, Pharmacy and Pharmacology 2017 | Vol 7 | Issue 4 (Online First)
RESEARCH ARTICLE
Role of honey as adjuvant therapy in patients with sore throat
Manpreet Singh Nanda1, Shiv Parshad Mittal2, Vipan Gupta1
1Department of Otolaryngology, Head and Neck Surgery, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan,
Himachal Pradesh, India, 2Department of Medicine, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan, Himachal
Pradesh, India
Correspondence to: Manpreet Singh Nanda, E-mail: u_tell_me_80@yahoo.co.in
Received: December 02, 2016; Accepted: December 25, 2016
ABSTRACT
Background: Honey is a natural product which has been used since ages for curing of various
ailments. Aims and Objectives: To evaluate the effect of honey for control of infection and inflammation in patients with
sore throat. Materials and Methods: A total of 200 patients with sore throat were taken up for the study. 100 patients,
in the study group, were given one tablespoon of honey twice a day along with anti-inflammatory drugs, antibiotics, and
antiseptic gargles. Remaining 100 patients in control group were given other same medications without honey. Patients were
evaluated after 5, 10 and 15 days for throat congestion, fever, pain, patient satisfaction, and other criteria. Results: There
was faster relief of signs and symptoms of sore throat in the study group as compared to control group. There was greater
patient satisfaction in the study group. Conclusion: Honey is effective in faster recovery of signs and symptoms of sore
throat having antibacterial and anti-inflammatory properties without causing any side effects.
KEY WORDS: Fever; Honey; Inflammation; Pharyngitis; Tonsillitis
INTRODUCTION
Medicinal importance of honey is known since ancient
times. It is said to possess antimicrobial property as well
as wound healing activity.[1] Honey though mainly made up
of sugars and water also contains vitamin B complex and
C with lots of minerals such as calcium, potassium, and
zinc.[2] Its broad spectrum antibacterial property against
pathogenic bacteria and oral bacteria like staphylococcus
and pseudomonas has been proved.[3] Honey is hygroscopic
so it can draw moisture out of the environment and
dehydrate bacteria and its high sugar content and low-level
pH also prevent microbes from growth.[4] Honey is known
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for its anti-inflammatory and antioxidant properties in
literature.[5]
Sore throat is one of the common symptoms of patients
visiting our ear, nose and throat (ENT) outpatient department
(OPD). It can be because of various inflammatory and
infective causes such as allergies, reflux disease, sinus
drainage, and tonsillitis. Sore throat can be of viral or infective
etiology.[6] Various treatments tried for sore throat have not
given satisfactory results. In various studies, local residents
have been found to use honey for pharyngitis and respiratory
ailments.[7] However, no scientific data are available in
literature regarding the same. Hence, we plan to conduct this
study to find out if honey has some role as an antibacterial,
anti-inflammatory, and antioxidant in treatment of sore throat
MATERIALS AND METHODS
This study was conducted on the patients visiting ENT and
medicine OPD of our medical college and hospital with
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DOI: 10.5455/njppp.2017.7.1233125122016
Nanda et al. Honey as adjuvant therapy in patients with sore throat
National Journal of Physiology, Pharmacy and Pharmacology 2
Volume 2 | Issue 4 | Sep-Oct 20152017 | Vol 7 | Issue 4 (Online First)
symptoms of sore throat from December 2015 to November
2016. 200 patients with signs and symptoms of sore throat
aged above 18 years of age were enrolled in this study after
taking written consent from the patients. The approval of
Institutional Ethical Committee was taken. Exclusion criteria
were patients with a history of diabetes, history of pollens
and bees allergy, allergic to honey those who were already
on treatment for sore throat and those with dislike to intake
honey. All the patients were examined and followed up by the
authors performing this study.
The patients were randomized alternatively into study and
control group. 100 patients in the study group were advised
to intake one tablespoon of honey twice a day slowly over
few minutes along with anti-inflammatory drugs, antibiotics,
and antiseptic gargles. Remaining 100 patients in the control
group were put only on antibiotics, anti-inflammatory drugs
and gargles without honey. The above treatments were given
maximum for 15 days or till the patients fully recovered from
sore throat whichever is earlier.
The patients were assessed after 5 days, 10 days, and
15 days after starting the treatment. The assessment points
were as follows:
1. Time to recovery - time taken to resolution of all signs
and symptoms of sore throat
2. The patients were assessed for subjective symptoms like
pain in throat, difficulty in swallowing and fever at each
visit
3. The oropharynx was examined at each visit for congestion
and other signs of sore throat
4. Complications - The patients were assessed for need for
hospitalization during the treatment period due to any
complications of sore throat such as high-grade fever,
dehydration, and severe painful swallowing
5. The patient satisfaction was assessed according
to LIKERT SCALE as 1 - completely satisfied,
2 - somewhat satisfied, 3 - no change/painful, 4 - not
satisfied/increased pain at each visit
6. The patients were enquired about any side effects on
taking honey.
RESULTS
A total of 200 patients who gave consent were enrolled in
this study. All the patients had complaints of sore throat. Data
were collected and analyzed. Patients above the age group of
18 years were taken in the study. There was an equal incidence
of sore throat in all the age groups. Male and female patients
were almost equal (Table 1).
About 200 patients with sore throat were taken up for the study.
100 patients in the study group were given one tablespoon
of honey twice a day along with anti-inflammatory drugs,
antibiotics, and antiseptic gargles. Remaining 100 patients
in control group were given other same medications without
honey. Patients were evaluated after 5, 10 and 15 days for
throat congestion, fever, pain, patient satisfaction, and other
criteria.
There was faster recovery from sore throat in study group
using honey than control group (Table 2).
Regarding individual signs and symptoms, there was
much faster recovery from fever within 5 days in the study
group as compared to control group (Table 3). The signs of
oropharyngeal congestion also had faster recovery in the
study group. There was no significant difference in patients
lost to follow-up in both groups (Table 3).
Regarding complications of sore throat, almost equal number
of patients in both groups needed hospitalization due to high
grade fever, severe odynophagia, dehydration, or other upper
respiratory tract complications (Figure 1).
Regarding patient satisfaction, patients in study group with
honey were more satisfied as compared to control group.
These results were more evident at first follow-up visit after
5 days (Table 4).
There were no side effects noted of honey in patients using
honey in the study group.
DISCUSSION
The role of honey as anti-inflammatory, antibacterial, and
antioxidant agent was investigated in this study. The aim of
the study was to evaluate honey in controlling inflammation
and infection in patients with sore throat and its affect on
patient satisfaction and to study its adverse effects if any.
We have used commercially available honey for this study.
All the patients were initially examined and followed up
Table 1: Age and sex distribution
Age group Male Female Total
18-40 years 43 39 82
41-60 years 33 37 70
>60 years 23 25 48
Total 99 101 200
Table 2: Time to total recovery from sore throat
Time taken Study
group (n = 100)
Control
group (n = 100)
<5 days 45 38
5-10 days 28 32
10-15 days 11 14
Not recovered after 15 days 7 8
Lost to follow-up 9 8
Nanda et al. Honey as adjuvant therapy in patients with sore throat
3 National Journal of Physiology, Pharmacy and Pharmacology 2017 | Vol 7 | Issue 4 (Online First)
by the authors performing this study in ENT and medicine
OPD. As it included subjective criteria, only adults above
age of 18 years were included in this study. There was faster
relief of signs and symptoms of sore throat in study group
as compared to control group. There was greater patient
satisfaction in study group.
Sore throat is clinical evidence of tonsillitis or pharyngitis
and is very common in everyone’s life.[8] According to Bisno
44% of patients with sore throat had infective etiology.[9] In
our study also we found that 74 patients (37%) had fever
which is a sign of infection (Table 3). Other causes of sore
throat according to literature are allergies and reflux disease.
According to various studies recurrence rate of sore throat
varies between 16% and 20% and need for hospitalization due
to complications are around 3-4%.[9] In our study, 9 patients
(5%) needed to be hospitalized due to causes such as high-
grade fever, severe odynophagia, dehydration and other
pulmonary complications (Figure 1). 15 (8%) patients in our
study had residual or recurrent disease even after 15 days of
treatment (Table 1).
Honey is a common household product used since
ages for various treatments and is easily accessible and
nonexpensive.[10] It is made up of 181 components[11] mainly
composing of fructose, glucose, fructooligosaccharides,
amino acids, vitamins, minerals, enzymes, and water.[12] The
main enzymes in honey are invertase, amylase and glucose
oxidase.[13] Glucose oxidase produces hydrogen peroxide
which has antimicrobial activity. In history Indian, Egyptian
and Greek texts have shown use of honey as antiseptic.[14]
Van Ketel, in 1892, first recognized antimicrobial activity of
honey.[15] Honey by drawing moisture out dehydrates bacteria.
It is pH and sugar content also inhibits micro-organisms.[16] In
a study by Olaitan et al., authors found honey to be inhibitory
on both Gram-positive and Gram-negative, aerobes and
anaerobes.[13] In our study, we found faster recovery of fever
(infection) in study group using honey as compared to control
group without honey within 5 days of treatment (Table 3).
According to Al-Waili and Boni honey ingestion has anti-
inflammatory effect.[17] Honey is said to reduce the activity
of cyclooxygenase-1 and cyclo oxygenase-2, thus showing
anti-inflammatory effect.[18] There is less edema, better
wound epithelization and tissue regeneration with honey.[17]
In our study, awe found faster recovery from oropharyngeal
congestion in study group using honey (Table 3). Honey
reduces prostaglandin E2 and alpha 2 in blood leading to
pain relief.[19] In our study, we found better relief and greater
patient satisfaction in study group using honey (Table 4). The
satisfactory results were achieved faster in the study group
as compared to control group, and there was faster recovery
using honey (Table 2).
Table 3: Relief of signs of sore throat
Signs Initial visit 1st follow-up (after
5 days)
2nd follow-up (after
10 days)
3rd follow-up (after
15 days)
Study
group
Control
group
Study
group
Control
group
Study
group
Control
group
Study
group
Control
group
Fever 38 36 18 26 5 7 2 2
Oropharyngeal congestion 100 100 48 56 18 22 7 8
Lost to follow-up - - 769898
Table 4: Patient satisfaction
Patient satisfaction 1st follow-up (after
5 days)
2nd follow-up (after
10 days)
3rd follow-up (after
15 days)
Study
group
Control
group
Study
group
Control
group
Study
group
Control
group
Completely satisfied 24 18 64 57 79 77
Somewhat satisfied 24 23 8 11 3 3
No change 20 21 7 9 3 3
Not satisfi ed (increased pain) 25 32 12 15 6 9
Figure 1: Need for hospitalization
Nanda et al. Honey as adjuvant therapy in patients with sore throat
National Journal of Physiology, Pharmacy and Pharmacology 4
Volume 2 | Issue 4 | Sep-Oct 20152017 | Vol 7 | Issue 4 (Online First)
The side effects of honey are rare. It can cause stinging pain
due to acidic pH.[20] No permanent resistance to honey has
been noted.[21] In our study, no side effects of honey were
noted.
There is scope of further studies regarding honey in other
infective disorders. There is also scope of study also including
children and seeing the affect of honey on them which could
be a limitation of our study. There are various subtypes of
honey available and comparative studies on each of them
could be done in future.
CONCLUSION
Honey is an easily available household product which has
anti-inflammatory, anti-infective and antioxidant properties
in the treatment of sore throat. Honey leads to faster recovery
of signs and symptoms of sore throat. Patient satisfaction is
much higher when honey is added to the treatment. The signs
and symptoms of pain, fever, and oropharyngeal congestion
recover much faster when honey is added to the therapy.
There are no side effects or resistance on intake of honey and
is considered as a safe remedy. Hence, we can conclude that
intake of honey as adjuvant therapy would benefit patients
with sore throat.
ACKNOWLEDGMENTS
We would like to thank our Medical College and Hospital
for its support and the patients for cooperating with the study
protocol.
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How to cite this article: Nanda MS, Mittal SP, Gupta V. Role
of honey as adjuvant therapy in patients with sore throat. Natl J
Physiol Pharm Pharmacol 2017;7 (Online First): Doi: 10.5455/
njppp.2017.7.1233125122016
Source of Support: Nil, Conflict of Interest: None declared.
... After screening 548 titles and abstracts, and 64 full-texts, nine unique RCTs that evaluated honeybee products for treatment of SARS-CoV-2 (1 RCT) 29 or acute viral RTIs (8 RCTs) [29][30][31][32][33][34][35][36][37] were included ( Figure 1). Except for one RCT that published the results clinical trial registry only, 37 they all were published in peer reviewed journals. ...
... (Supplement 5: Table 5.2). The type of honey was not specified in three RCTs [34][35][36] and subgroup analyses comparing efficacy of different honey types was not 13 conducted due to insufficient numbers. Adverse events were analyzed per-participant, except for honey when compared to placebo for the duration of cough in children, in which the most frequent adverse event (vomiting) was synthesized. ...
... Honey was evaluated for reduced symptom severity in three RCTs including 420 adults with acute RTI cough, 37 pharyngitis/tonsilitis, 36 and persistent postinfectious cough. 35 Honey was less effective than a guaifenesin tablet at reducing the severity of cough one-hour post intervention, there were no differences for honey compared to a placebo tablet, and there were no differences in the risks of non-serious adverse events when honey was compared to either guaifenesin or placebo. ...
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... Honey also has properties or the ability to kill/inhibit the growth of germs. Honey also functions as a catalyst that can accelerate healing (Nanda et al., 2017). Honey also functions as an antiviral and therapeutic (Hossain et al., 2020;Naggar et al., 2021). ...
... Honey as a catalyst to accelerate disease healing was studied by Nanda (Nanda et al., 2017). They studied 200 patients with a sore throat. ...
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... 15 Therefore, patients complain about throat pain, particularly during swallowing. 16,17 When used regularly after tonsillectomy, honey may have benefits on tissue repair, thereby reducing post-operative pains. 17 The application of honey may reduce inflammation of infected wounds and facilitate the healing time duration. ...
... 24 However, allergic reactions may rarely develop against some of the pollens included in honey and sometimes contain clostridia spores that lead to botulism. 16 Therefore, the patients receiving honey should be asked whether they are allergic to honey. 17 This study is not without limitation. ...
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... Regarding the temperature score, unlike the study by [19], [26], who found that there was significantly faster recovery of fever within 5 days of the study in the honey group [18], [22], the present study did not show a significant difference between the two groups (0.03°). The results of the "quality of sleep" variable indicate that the honey group did not show a better quality of sleep than the reference group. ...
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... [9] While the results of Boroundman and Lal's study, it was found that the honey group significantly lowered the pain scale from day one. [7,13] Tuhanioglu & Erkan. [1] and Boroumand, et al. [7] confirms that oral administration of honey following tonsillectomy relieve postoperative pain and decrease the need for analgesics after surgery. ...
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Context: Tonsillectomy is one of the most common childhood operations. Postoperative complications of tonsillectomy include pain, nausea and vomiting, interruption of oral intake, airway obstruction with respiratory compromise, and primary or secondary postoperative bleeding. Historically, honey has been used for wound control, reducing the inflammation, and healing acceleration. Aim: This study aimed to evaluate the effects of honey on reducing of postoperative pain and decreasing of analgesic dosage among tonsillectomy children 3-15 years old. Study Design: quasi-experimental study design was used. Materials and Methods: Forty patients were randomly divided in two equal groups. Control group were treated with traditional treatment (acetaminophen and antibiotic), while, case group were treated with (acetaminophen, antibiotic and 10 ml of pure honey every 8 hours). Data was gathered via interview of child relatives at the first day of operation than through telephone number the researcher fill questionnaire about pain score assess through Visual analogue scale (VAS) and number of painkiller taken through seven follow-up day. Statistical Analysis: Data was analyzed by SPSS 17 software and related tests. Results: Pain comparison between two groups illustrated that the average time required for pain relief in patients who received honey was less than the control. The pain intensity was higher during the first 7 days post-operatively in control group. Results also showed that acetaminophen consumption in patients who received honey is lower. Conclusion: Honey has positive effect in reducing post tonsillectomy pain, and decreasing analgesic dosage and it can be used as an adjunctive regimen after surgery for better pain control.
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Background Antibiotic over prescription for upper respiratory tract infections (URTIs) in primary care exacerbates antimicrobial resistance. There is a need for effective alternatives to antibiotic prescribing. Honey is a lay remedy for URTIs, and has an emerging evidence base for its use. Honey has antimicrobial properties, and guidelines recommended honey for acute cough in children. Objectives To evaluate the effectiveness of honey for symptomatic relief in URTIs. Methods A systematic review and meta-analysis. We searched Pubmed, Embase, Web of Science, AMED, Cab abstracts, Cochrane Library, LILACS, and CINAHL with a combination of keywords and MeSH terms. Results We identified 1345 unique records, and 14 studies were included. Overall risk of bias was moderate. Compared with usual care, honey improved combined symptom score (three studies, mean difference −3.96, 95% CI −5.42 to −2.51, I ² =0%), cough frequency (eight studies, standardised mean difference (SMD) −0.36, 95% CI −0.50 to −0.21, I ² =0%) and cough severity (five studies, SMD −0.44, 95% CI −0.64 to −0.25, I ² =20%). We combined two studies comparing honey with placebo for relieving combined symptoms (SMD −0.63, 95% CI −1.44 to 0.18, I ² =91%). Conclusions Honey was superior to usual care for the improvement of symptoms of upper respiratory tract infections. It provides a widely available and cheap alternative to antibiotics. Honey could help efforts to slow the spread of antimicrobial resistance, but further high quality, placebo controlled trials are needed. PROSPERO registration No Study ID, CRD42017067582 on PROSPERO: International prospective register of systematic reviews ( https://www.crd.york.ac.uk/prospero/ ).
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