Review: evidence on the effectiveness of honey for healing wounds is limited
A B Jull
Dr A B Jull, University of Auckland, Auckland, New Zealand;
Does topical honey improve rate of healing of acute and chronic wounds?
Included studies compared topical honey, alone or in combination with other dressing components, with dressings or other topical agents for healing acute wounds (burns, lacerations, and other traumatic wounds) and chronic wounds (venous or pressure ulcers and infected wounds healing by secondary intention), and reported data for ⩾1 primary outcome. Primary outcomes were time to complete wound healing and proportion of patients with completely healed wounds.
Cochrane Wounds Group Specialised Register (May 2008), Cochrane Central Register of Controlled Trials (Cochrane Library, Issue 2, 2008), Medline (1950 to May 2008), CINAHL (1982 to May 2008), EMBASE/Excerpta Medica (1980 to wk 21, 2008), LILACS (1982 to Oct 2006), AMED (1985 to Oct 2006), Google Scholar, and reference lists were searched for randomised controlled trials (RCTs) and quasi-RCTs. Trial authors, experts, and manufacturers of honey products for wound care were contacted. 19 trials (n = 2554) met the selection criteria: 12 included patients with acute wounds, 5 included those with chronic wounds, and 2 included both types of wounds. 5 trials clearly reported adequate generation of allocation sequence, 4 reported adequate allocation concealment, 16 had <20% loss to follow-up, 14 had blinded outcome assessors, 2 used intention-to-treat analysis, and 17 had comparable groups at baseline. 11 trials were done by the same investigator.
Results of some trials were not pooled because of variation in patient populations and interventions. Meta-analysis showed that honey reduced time to wound healing more than conventional dressings for acute, partial thickness burns and did not differ from other treatments for other wound types (table).
Topical honey is better than conventional dressings for healing acute burns but not chronic venous ulcers. Evidence is insufficient to evaluate honey for healing other types of wounds.
Jull AB, Rodgers A, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev 2008;(4):CD005083.
Clinical impact ratings: Family/general practice 7/7; General/internal medicine 5/7; General surgery 5/7; Wound care 6/7
The extensive literature available on use of honey as a treatment for wounds is mainly positive.1 The review by Jull et al posed a clearly formulated question and included trials completed after an earlier review was published,2 thereby ensuring that evidence for practice is current.
Jull et al included a detailed and comprehensive search strategy covering a range of conventional databases and a search of the internet, augmented by studies included in reference lists and from manufacturers of wound treatment products. Both published and unpublished trials were considered. Because the review considered wounds by type (acute, mixed acute-chronic, and different types of chronic wounds), meaningful meta-analysis and some appropriate summary statistics could be provided. The quality of the review was enhanced by inclusion of only randomised or quasi-randomised trials. However, robust conclusions could not be made because of the poor quality of many trial reports. Good-quality evidence indicated that honey does not have a significant effect on healing of leg ulcers, and poor-quality evidence supports treatment of mild-to-moderate superficial and partial thickness burns with honey. The lack of good-quality evidence perpetuates uncertainty, and until there is better evidence in the form of well-designed RCTs, honey should not be used routinely as a treatment for wounds.