Published clinical data

This chapter is intended to provide a broad overview of the current clinical data published on honey in wound management. It is not presented as a review, systematic or otherwise. Whilst honey and honey-based treatments have been used on wounds for millennia, it is only recently that we have seen any attempt to provide meaningful clinical data on medical grade honey products. This is not to discount all previous data, as that does have a role in guidance. According to Molan (2002):

Dressing wounds with honey, a standard practice in past times, went out of fashion when antibiotics came into use. Because antibioticresistant bacteria have become a widespread clinical problem, a renaissance in honey use has occurred.

In the past two decades, numerous laboratory studies and clinical trials have shown that honey is an effective broad-spectrum antibacterial agent that has no known adverse effects on wound tissues. Clinically, topical honey treatment has been shown to have many key actions:

  • antibacterial and antimicrobial
  • autolytic debridement
  • deodorises wounds
  • stimulates growth of wound tissues to hasten healing and to start the healing process in dormant wounds
  • anti-inflammatory activity rapidly reduces pain, oedema, and exudate and minimises hypertrophic scarring
  • moist wound healing.

When looking at clinical evidence it is important to rank the available information according to current standards, thus a randomised clinical trial (RCT) is recognised as the highest level of clinical evidence. Such trials are very expensive in terms of time to plan, conduct, analyse and report, and, in terms of financial costs. However, this should not, and does not, discount all other evidence (Rolfe, 1999). A systematic review has been conducted on the published evidence on honey in wound care (Moore et al, 2001). This concluded that the evidence available (at that time) from seven comparative studies on 264 patients was limited by lack of ‘blinding’, poor reporting and poor validity. Much has changed since the Moore review; quality comparative studies have been set up and preliminary data reported on the new generation of ‘Medical Device grade’ honey products.

Until very recently, the honey used in wound management has been generic, non-sterile material, sourced from supplies intended for nutritional rather than medical use. However, in recent years, we have seen a number of honey-based wound treatments come to the UK market with the European Conformity (CE) mark and regulatory approval as sterile Medical Devices for use on full-thickness wounds (NZX, 2005).

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Published clinical data