Many of the studies included in these SRs did not report on the type of honey that was used. For those that did report, the honey ranged from fresh, unaltered honey to irradiated medical grade honey (e.g., MediHoney). This makes it difficult to generalize the results to the Canadian context and to the types of medical grade honey that are available for use by Canadian practitioners. Further research, including properly blinded RCTs, is likely necessary to help to support the use of honey for wounds as a part of standard practice. Medical-grade honey, most recognized under the brand-name MEDIHONEY by Derma Sciences, is derived from the flower of the Manuka plant ( Leptospermum) of New Zealand, the most studied of all honey types. The source of the nectar finely tunes the properties of the honey, determining flavor, color and, in this case, medicinal benefits. Manuka honey offers an antibacterial environment that is superior to ordinary honey. In some countries, sterilized MEDIHONEY is available as a prescription. MEDIHONEY is a registered medical device in the United Kingdom and Australia; in the US, medical-grade honey dressings are being used in healthcare settings more frequently than ever before. MEDIHONEY is a brand name wound and burn gel made from 100% Leptospermum (Manuka) honey. Manuka honey is unique in that it has antibacterial and bacterial resistant properties, meaning it prevents bacteria from building a tolerance to its beneficial effects. According to a literature review published in the journal Wounds, honey offers the following benefits in healing wounds:

Acidic pH promotes healing. Honey has an acidic pH of between 3.2 and 4.5. When applied to wounds, the acidic pH encourages the blood to release oxygen, which is important to wound healing. An acidic pH also reduces the presence of substances called proteases that impair the wound healing process.Although the mechanism(s) by which honey speeds up the healing process have not been determined, there are some findings, which provide possible explanations. One way in which honey may work is through its stimulation of an inflammatory response in leukocytes ( 28, 29, 33), as inflammation is what triggers the cascade of cellular events that give rise to the production of growth factors which control angiogenesis and proliferation of fibroblasts and epithelial cells. Very recently, Tonks et al. discovered a 5.8kDA component of manuka honey which stimulates the production of TNF-α in macrophages via Toll-like receptor 4 ( 34). Kateel et al. 14 found that three of five RCTs concluded that topical honey was better than conventional dressings for the healing of diabetic foot ulcers while two of the five RCTs found no difference in healing between the two treatments. No adverse events were reported. 14 The authors also included observational studies that reported greater efficacy, decreased amputation, and better compliance with honey for diabetic foot ulcer. 14 Two of the five RCTs summarized by Kateel et al. 14 were also included in the broader SR by Jull et al. 15 Medical-grade honey has an impressive profile of bacteria-fighting properties-- crucial in a time where emerging antibacterial resistance poses a serious challenge to the healthcare community and public at large. MEDIHONEY dressings are incredibly effective as an occlusive barrier, protecting the damaged tissue from pathogens and in some cases, reducing the pain and discomfort of wound dressing changes. Facilities that use MEDIHONEY dressings often find that unpleasant wound odor is reduced. Inflammation also tends to subside with the application of medical-grade honey. MediHoney Paste dressings with 100% Active Leptospermum Honey is ideal for use in hard to dress wounds areas such as tunneled wounds, sinus wounds and wounds with undermining. The MediHoney Paste dressing has the ability to seep down into areas of the wound you may not be able to reach with other dressings. Apply the MEDIHONEY gel or paste directly to the wound. If you’re using a calcium alginate dressing, use sterile scissors to resize it, and then gently apply the dressing to the wound bed.

When honey is diluted with water, reducing its high sugar content, it still inhibits the growth of many different bacterial species that cause wound infections ( 14, 15, 17–20). Honey is one of the few nutritive substances that does not spoil. In fact, still-edible honey has been discovered in 2,000-year-old sealed pots safely nestled within the final resting places of Egyptian pharaohs. There is a growing body of research evidence that supports the use of medical-grade honey as a top choice in advanced wound care treatment options. Healthcare professionals are increasingly using this medicinal substance in their practice. Medical researchers have long proven that the pH of a wound (specifically the surface area) influences all of the processes that occur at the cellular level over the course of healing. Honey is unique among sugars because of its acidity and low pH (3.2 to 4.5). This pH level is low enough to inhibit the growth of a number of dangerous bacterial pathogens: E. coli, Salmonella and P. aeruginosa are just a few examples among others. The low pH level of honey and subsequent capability to regulate the acidity of the wound environment and surrounding tissue is a crucial component in honey's ability to heal. Another mechanism may be related to the pH level of honey being low (3.4–5.5; mean 4.4) ( 35, 36). Bacterial colonization or infection and recalcitrant wound healing situations are often accompanied by pH values >7.3 in wound exudates ( 37, 38). It has been demonstrated that acidification of wounds speeds healing ( 39), this being attributed to the low pH increasing the amount of oxygen off-loaded from hemoglobin in the capillaries. More recently it has also been attributed to suppression of protease activity in wounds by getting away from the neutral pH that is the optimum for their activity ( 37). Excessive protease activity in a wound can slow or prevent healing by destroying growth factors (which are proteins) and destroying the protein fibres and fibronectin in the wound matrix, attachment to which activates fibroblasts and is necessary for the migration of these and of epithelial cells ( http://www.worldwidewounds.com/2005/august/Schultz/Extrace-Matric-Acute-Chronic-Wounds.html). This protease activity results from excessive inflammation. The anti-inflammatory activity of honey would thus remove this impediment to healing, as would the antibacterial activity working through removing infecting bacteria stimulating the inflammatory response. Unlike regular honey, MediHoney is controlled against a rigorous set of systems and standards, including independent monitoring and auditing, to guarantee quality and batch-to-batch consistency. It is also ultra-filtrated and sterilized by gamma irradiation, removing any bacterial spores without loss of product effectiveness. 3 MediHoney comes from a traceable source and is free of pesticides and antibiotics. 3Sugar has an osmotic effect. The sugar naturally present in honey has the effect of drawing water out of damaged tissues (known as an osmotic effect). This reduces swelling and encourages the flow of lymph to heal the wound. Sugar also draws water out of bacterial cells, which can help keep them from multiplying.

Ideally, a person should use medical-grade honey, which is sterilized and therefore less likely to cause immune system reactions. If you have any questions about applying honey to your wound, follow up with a physician. Types of honey used on wounds Kamaratos AV, Tzirogiannis KN, Iraklianou SA, Panoutsopoulos GI, Kanellos IE, Melidonis AI. Manuka honey-impregnated dressings in the treatment of neuropathic diabetic foot ulcers. Int Wound J. 2012 ; 9: 1-7. If you care for a loved one with underlying health problems like diabetes or venous insufficiency, MEDIHONEY can reduce the risk of infections, support the removal of necrotic tissue, and encourage the body’s natural wound healing process. https://journals.lww.com/nursing/Citation/2014/07000/What_s_the_buzz_about_medical_grade_honey_.17.aspxIn one randomized controlled trial, the mean healing time of wounds treated with MediHoney dressings was significantly faster than the mean healing time of wounds treated with conventional dressings. 4 Robson, V., Dodd, S and Thomas, S. Standardized antibacterial honey (MediHoney®) with standard therapy in wound care: randomized clinical trial. Journal of Advanced Nursing, 2009: p. 565-575. Honey is a sugary, syrupy substance that has been shown to have bioactive components that can help heal wounds. MEDIHONEY has become the go-to wound care product for many Americans. It comes in both prescription-strength and over-the-counter formulas and provides a safe, effective, way to manage burns, arterial ulcers, and surgical wounds. The change frequency of MediHoney dressings depends on the condition of the patient’s wound as well as the level of wound exudates. MediHoney dressings should be reapplied when the primary secondary dressing has reached its absorbent capacity.

The anti-inflammatory action of honey has been extensively observed clinically ( 19, 28, 29) and in animal models ( 15). Animals do not demonstrate any placebo effects, as they are incapable of having attitudes influence their healing process, such as believing that natural products would be more effective, or from hearing via the news media of the effectiveness of honey in wound treatment ( 30). Thus, these observational and histological studies can be cited as convincing evidence for the positive results with honey not being due to a placebo effect. Similarly, this can be concluded also for the observations in wounds in animal models of honey stimulating the rate of angiogenesis, granulation and epithelialization ( 31, 32), which would explain the findings in clinical trials that honey speeds up the healing process ( 15). While this is more of an idea than something that is proven, it’s important to be aware of the risks, according to the journal Wilderness & Environmental Medicine. IneffectiveIn addition to its antibacterial properties, medical honey hastens the healing of wounds through its anti-inflammatory effects. The amount of wound exudate is related to the activity of the local inflammatory process, in particular in wounds, which are colonized or infected with bacteria. Thus, the anti-inflammatory action of honey reduces oedema and the amount of exudate by down regulating the inflammatory process. It also reduces pain, as the pain in wounds results from the nerve endings being sensitized by prostaglandins produced in the process of inflammation, as well from the pressure on tissues resulting from oedema.