Honey has been used in the treatment of wounds for over 2,000 years, being first documented by the Egyptians in 2,000 B.C. Recently in Nigeria, undiluted honey was used on a variety of wounds, including Fournier’s gangrene and burns. Honey was found to reduce the number of positive swab cultures and was used to debride sloughy and necrotic tissues. There was less exudate and a reduction in “foul-smelling” wounds. Studies conducted in 1998 and 1999 in India used honey to treat burns, and a study conducted in 2000 in England used honey to successfully treat chronically infected meningococcal skin lesions. Sugar solutions and pastes have a high osmolarity and can bind water to inhibit bacterial growth. However, exudates derived from wounds can dilute sugar and paste preparations, causing them to lose their effectiveness. Honey’s antibacterial properties are derived from the presence of hydrogen peroxide, which is released by the action of the enzyme peroxidase that is added by bees to the nectar they collect. Hydrogen peroxide is harmful to tissues when applied as a rinse solution, but continuous production of hydrogen peroxide at a nontoxic level of approximately 1,000-fold lower than those used in rinse solutions provides consistent antibacterial action. There are additional antibacterial agents from plant-derived chemicals, such as bioflavonoids. Honey has a deodorizing action when used in wound dressings. This is due to the antibacterial activity of honey against the organisms that cause odor. Foul smells are generated by anaerobes, such as bacteroides and clostridium species. Gram-negative rods, such as pseudomonas and proteus species, are inhibited by honey. Commercial honeys intended for use on wounds are available. They havestandardized antibacterial activity and have been sterilized by gamma irradiation. The fluidity of honey can be increased by warming the honey in lukewarm water, but excessive heating can destroy its antibacterial activity. A typical dressing of honey would consist of approximately 25-35 g of active honey added to an absorbent pad. This would be secured on the wound with a secondary dressing, which can be held in place by tubular dressing or bandages. Honeys from the Leptospermum species, such as manuka honey, have high levels of plant-derived antibacterial activity. An adhesive, waterproof film acting as a secondary dressing may help prevent leakage, if there is not too much exudate. The advantages of using honey on wounds are: it creates an antibacterial and moist environment; it provides a bacterial barrier that prevents cross-infection; honey rapidly removes infecting bacteria, including antibiotic-resistant strains; it removes odor; honey has an anti-inflammatory action; it debrides the wound; it prevents scarring and hypertrophy; it promotes wound healing through stimulation of tissue regeneration; there are no advers effects on wound healing; it reduces the need for grafting; and it is not adherent. The disadvantages of using honey on wounds include: it becomes more fluid at higher temperatures and may liquefy at wound temperature; because it can liquefy, it restricts the body site on which it can be used, due to the problem of leakage; preparing an impregnated dressing is difficult and nonsterile; there is a remote risk of botulism from a non-sterilized product; and, in some patients, there is a “drawing” or stinging sensation, which can cause some discomfort. “The Use of Honey in Wound Management,” Dunford C, Cooper R, Molan P, White R, Nursing Standard, November 29, 2000;15(11):63-68. (Address: Rose Cooper, PhD, Univ Wales Institute, Cardiff, School of Appl Sci, Western Avenue Cardiff, Wales CF5 2YB, United Kingdom, 029 2041 6070) 36691
CONSIDER: One of the unique points in this review article is not so much the antibacterial activity of sugar and honey but how their benefit in wound healing is different. While both honey and sugar have a high osmolarity and can bind water to inhibit bacterial growth, honey has an additional antibacterial activity that comes from plant phytochemicals, as well as the production of hydrogen peroxide. This low-grade secretion of hydrogen peroxide is produced by the activity of the glucose oxidase enzyme that is present in honey. We find, again, that there is a beneficial effect of hydrogen peroxide at a low-dose when produced by the honey in the wound, but at very high concentrations (when used as a rinse), it is damaging to wound healing.
WOUND HEALING – Honey, Pseudomonas – In isolating Pseudomonas sppfrom 20 infected wounds and placing them in pure cultures with various concentrations of manuka honey and pasture honey, the minimum inhibitory concentration of manuka honey for the 20 isolates ranged from 5.5-8.7% (v/v). The minimum inhibitory concentration of pasture honey for the 20 isolates ranged from 5.8-9.0% (v/v). These data suggest that honeys with average antibacterial activity would be expected to prevent the growth of Psuedomonas on the surface of a wound, even if the honeys were diluted more than 10-fold by the exudates that are produced by the wound. “The Use of Honey as an Antiseptic in Managing Pseudomonas Infection,” Cooper R, Molan P, J Wound Care, April 1999;8(4):161-164. 36690B
WOUND HEALING – Honey, Staphylococcus Aureus – In evaluating 58 strains of coagulase-positive Staphylococcus aureuswhich were isolated from infected wounds, utilizing a pasture honey and a manuka honey, minimum inhibitory concentrations were between 2% and 3% (v/v) for the manuka honey and between 3% and 4% for the pasture honey. These honeys could still prevent the growth of Staphylococcus aureusif diluted by body fluids by an additional 7- to 14-fold beyond the point where their osmolarity ceased to be completely inhibitory. Pasture honey maintains its antibacterial action through the release of hydrogen peroxide. Manuka honey additionally has a phytochemical component, which may inhibit Staphylococcus aureus growth. “Antibacterial Activity of Honey Against Strains of Staphylococcus aureusFrom Infected Wounds,” Cooper RA, Molan PC, Harding KG, J R Soc Med, June 1999;92:283-285. 36690A
WOUND HEALING – Honey, Sugar, Ulcer – Honey can enhance wound healing by its antibacterial properties, but it can be runny and sticky in nature. Adhesive occlusive dressings can seal the honey dressing in place. The leaking of honey-laden exudate into a secondary dressing and bedding can be prevented by covering the primary dressing with a plastic film, such as food-wrap. Since honey has a high osmolarity, it prevents the maceration of skin that surrounds the wound. If honey isn’t used, maceration might occur with these occlusive dressings. When the honey is contained in the primary dressing, insects cannot come in contact with the honey. Honey has considerable deodorizing capabilities. Honey dressings have to be changed less frequently than sugar dressings to maintain the osmolarity of the mixture and to inhibit bacteria. Honey has no adverse effect on tissues, whereas antibacterial substances can cause damage to tissues. Honey can increase the rate of granulation and epithelialization of wounds. Low levels of hydrogen peroxide are continuously produced by the activity of glucose oxidase, which is an enzyme present in honey, unlike sugar, that provides the antibacterial properties. The antibacterial potency of honey can vary 100-fold, due to the differences in the amount of hydrogen peroxide produced by the honey. The level of antibacterial activity in honey can be evaluated in a microbiology laboratory, or it can be evaluated by comparing the amounts of individual honeys having to be added to milk to prolong souring times. Honey needs to be stored away from heat and light to maintain its antibacterial activity. “Honey and Sugar as a Dressing for Wounds and Ulcers,” Molan PC, Cooper RA, Tropical Doctor, October 2000;30:249-250. 36689