Clearance of infection

Applying honey dressings to wounds has been reported to:

• Clear infection rapidly
  (Cavanagh et al, 1970; Armon, 1980; Braniki, 1981; Phuapradit and Saropala, 1992; Efem, 1993; Anoukoum et al, 1998; Robson et al, 2000; Betts and Molan, 2001; Kingsley, 2001; Subrahmanyam et al, 2001; Alcaraz and Kelly, 2002)
  
  
• Heal deeply infected surgical wounds
  (Cavanagh et al, 1970; Armon, 1980; Bergman et al, 1983; McInerney, 1990; Phuapradit and Saropala, 1992; Vardi et al, 1998; Al-Waili and Saloom, 1999; Cooper et al, 2001)



• Halt advancing necrotising fasciitis
  (Efem, 1993; Hejase et al, 1996).

Wounds not responding to conventional therapy with antibiotics and antiseptics have been healed by application of honey dressings (Efem, 1993; Harris, 1994; Wood et al, 1997; Vardi et al, 1998; Dunford et al, 2000a, b; Cooper et al, 2001), including wounds infected with methicillin-resistant Staphylococcus aureus (MRSA) (Dunford et al, 2000a; Natarajan et al, 2001), Pseudomonas aeruginosa (Dunford et al, 2000b) and other bacteria resistant to antibiotics (Al-Waili and Saloom, 1999).

The laboratory evidence for the potent broad-spectrum antimicrobial activity of honey is covered in Chapter 2, as is the stimulatory action of honey on leukocytes — another mechanism by which honey may work to clear infection from wounds. There is no clear evidence of the ability of the antibacterial activity of honey to diffuse down into wound tissue when applied as a wound dressing. But, the suppression by honey of growth of any bacteria already present on the surface of the wound means that there is not the problem of malodorous dressings when hydrocolloid dressings are used. Being a source of toxins and pyrogens, honey also removes the problem of bacteria growing on the wound surface. However, the rapid clearance of a deep-seated infection (Cooper et al, 2001) and of boils with unbroken skin (Betts and Molan, 2002) by topical application of honey indicates that the antibacterial activity of honey probably does diffuse though skin. If this is so, it is important to use a honey with a high level of antibacterial activity (Chapter 2) to achieve an effective level of antibacterial activity below the surface. When diffusion occurs, there is a gradient formed of decreasing concentration from the source (in this case, the dressing on the surface of the wound). As illustrated in Figure 1.1, the minimum concentration of antibacterial component that will stop bacterial growth will be deeper down in the wound tissue if the source has a higher concentration. It is also important to keep a substantial quantity of honey on the surface (eg. by using a dressing pad soaked with honey), so that the concentration of antibacterial activity on the surface does not become low through dilution by exudate, or depletion by diffusion into the underlying tissue.

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