THE EFFICACY OF HONEY AS AN ALTERNATIVE TO STANDARD ANTISEPTIC CARE IN THE TREATMENT OF CHRONIC PRESSURE ULCERS AND DIABETIC FOOT ULCERS IN ADULTS

GF PEREIRA; M BALMITH; M NELL

doi:10.22159/ajpcr.2021.v14i11.42560

Authors

GF PEREIRA Department of Pharmacology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia 0007, Pretoria, South Africa.
M BALMITH Department of Pharmacology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia 0007, Pretoria, South Africa.
M NELL Department of Pharmacology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia 0007, Pretoria, South Africa.

DOI:

https://doi.org/10.22159/ajpcr.2021.v14i11.42560

Keywords:

Pressure ulcers, Diabetic foot ulcers, Antiseptics, Povidone-Iodine, Honey, Wound healing

Abstract

Objective: A chronic wound fails to progress through the phases of wound healing in an orderly and appropriate process, and poses a major challenge to wound care professionals. Pressure ulcers (PUs) and diabetic foot ulcers (DFUs) are classified as chronic wounds. Antiseptics, such as povidone-iodine (PVP-I), are often used to treat bacterial infections in chronic wounds; however, their efficacy and ability to accelerate wound healing has come into question. As a result, current medical research is now focusing on alternative and natural antiseptic agents, such as honey, for the treatment of chronic wounds. The aim of this study was to analyze the wound healing effects of honey in PU and DFU treatment in comparison to standard antiseptic care.

Methods: A systematic literature search of PubMed, ScienceDirect, and ClinicalKey was conducted to identify all published data of clinical trials and narrative reviews that investigated or reported the use of honey and standard antiseptics in the treatment of PUs and DFUs in adults. A keyword search was then performed using the following keywords: “PUs”, “DFUs”, “antiseptics”, “PVP-I”, “honey”, “Manuka honey (MH)”, and “wound healing”. Database restrictions were implemented based on the inclusion and exclusion criteria, notably the report’s availability, completion status and language, the sample populations’ age, as well as, the date of publication. A preferred reporting item for systematic review and meta-analysis (preferred reporting items for systematic reviews and meta-analyzes) diagram was constructed illustrating the study selection process. The eligibility of articles was assessed by the screening of titles, abstracts and full texts. A total of 12 articles were included in this study comprising of 775 patients with PUs, DFUs or a combination of PUs and DFUs.

Results: Results indicated that honey reduced bacterial infection, reduced pain and edema experienced by patients, reduced the odor of the wound and promoted wound healing in the treatment of chronic ulcers. Honey was also found to be effective in the process of debridement and exudate removal.

Conclusion: Honey was found to be highly effective in the treatment of PUs and DFUs and should be considered as an alternative to standard antiseptic care in the treatment of chronic wounds. However, the literature in this study is limited and so further research into honey and its antiseptic-promoting activity in wound healing is recommended.

Downloads

Download data is not yet available.

References

Smith ME, Totten A, Hickam DH, Rongwei F, Wasson N, Basmah R, et al. Pressure ulcer treatment strategies: A systematic comparative effectiveness review. Ann Intern Med 2013;159:39-50.

Van Devender Y, Bester P. Holistic care for patients living with chronic wounds. Wound Healing Southern Afr 2015;8.

Anders J, Heinemann A, Leffmann C, Leutenegger M, Pröfener F, von Renteln-Kruse W. Decubitus ulcers: Pathophysiology and primary prevention. Dtsch Arztebl Int 2010;107:371-81.

Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: A systematic review and meta-analysis. Ann Med 2017;49:106-16.

Chronic Wounds; c2008-2021. Available from: https://www. woundsource.com/patientcondition/chronic-wounds. [Last accessed on 2021 Apr 26].

Alex R, Ratnaraj B, Winston B, Samson Devakiruba DN, Samuel C, John J, et al. Risk factors for foot ulcers in patients with diabetes mellitus-a short report from vellore, South India. Indian J Community Med 2010;35:183-85.

Gethin G. The role of antiseptics in pressure ulcer management. Nurs Stand 2011;26:53-60.

Pressure Ulcers; c2020. Available from: https://www.physio-pedia. com/Pressure_Ulcers. [Last accessed on 2021 Mar 02].

A Guide to Pressure Ulcer Prevention and Management from the Victoria Quality Control Australia; c2004. Available from: http://www. elearning.health.vic.gov.au/PressureUlcerBasics/module1/topic2/ page11.htm. [Last accessed on 2021 Mar 02].

Alderden J, Rondinelli J, Pepper G, Cummins M, Whitney J. Risk factors for pressure injuries among critical care patients: A systematic review. Int J Nurs Stud 2017;71:97-114.

Bluestein D, Javaheri A. Pressure ulcers: Prevention, evaluation, and management. Am Fam Physician 2008;78:1186-94.

Bhattacharya S, Mishra RK. Pressure ulcers: Current understanding and newer modalities of treatment. Indian J Plast Surg 2015;48:4-16.

Here Are the Key Forces that Cause Pressure Ulcers; c1997. Available from: https://www.reliasmedia.com/articles/48517-here-are-the-key-forces-that-cause-pressure-ulcers. [Last accessed on 2021 Mar 02].

Diabetic Foot-risk Factors and Prevention; c2008-2021. Available from: https://www.woundsource.com/blog/diabetic-foot-risk-factors-and-prevention. [Last accessed on 2021 Apr 26].

Diabetic Foot Ulcers: Pathogenesis and Management; c2002. Available from: https://www.aafp.org/afp/2002/1101/p1655.html. [Last accessed on 2021 Apr 26].

Diabetic Foot Ulcers: Prevention, Diagnosis and Classification; c1998. Available from: https://www.aafp.org/afp/1998/0315/p1325.html. [Last accessed on 2021 Apr 26].

Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res 2010;89:219-29.

Kruse I, Edelman S. Evaluation and treatment of diabetic foot ulcers. Clin Diabetes 2006;24:91-3.

Mandal MD, Mandal S. Honey: Its medicinal property and antibacterial activity. Asian Pac J Trop Biomed 2011;1:154-60.

Drosou A, Falabella A, Kirsner RS. Antiseptics on wounds: An area of controversy (part one). Wounds 2003;15:149-66.

Gulati S, Qureshi A, Srivastava A, Kataria K, Kumar P, Balakrishna Ji A. A prospective randomized study to compare the effectiveness of honey dressing vs. Povidone iodine dressing in chronic wound healing. Indian J Surg 2014;76:193-8.

Does Honey Ever Go Bad? What You Should Know. Healthline; c2020. Available from: https://www.healthline.com/nutrition/does-honey-go-bad. [Last accessed on 2021 Mar 10].

Vandamme L, Heyneman A, Hoeksema H, Verbelen J, Monstrey S. Honey in modern wound care: A systematic review. Burns 2013;39:1514-25.

Olas B. Honey and its phenolic compounds as an effective natural medicine for cardiovascular diseases in humans? Nutrients 2020;12:283.

Alvarez-Suarez JM, Gasparrini M, Forbes-Hernandez TY, Mazzoni L, Giampieri F. The composition and biological activity of honey: A focus on Manuka honey. Foods 2014;3:420-32.

Zeleníková R, Vyhlídalová D. Applying honey dressings to non-healing wounds in elderly persons receiving home care. J Tissue Viability 2019;28:139-43.

Khadanga S, Dugar D, Karuna T, Khetri R, Tim H, Ghata S, et al. Effects of topical honey dressing in decubitus ulcer. Asian J Med Sci 2015;6:99-110.

Choudhary KN, Soni P, Singh R. Comparative study of honey and betadine in chronic ulcer healing. J Evid Based Med 2015;2:6877-82.

Shukrimi A, Sulaiman AR, Halim AY, Azril A. A comparative study between honey and povidone iodine as dressing solution for Wagner Type II diabetic foot ulcers. Med J Malaysia 2008;63:44-6.

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 2014;11:259-63.

Agarwal S, Bhardwaj V, Singh A, Khan H, Goel S, Bhara M. A control clinical trial of honey-impregnated and povidone iodine dressings in the treatment of diabetic foot ulcers among Northern Indian subjects. Indian J Sci Res 2015;6:7-10.

Hammouri SK. The role of honey in the management of diabetic foot ulcers. J Res Med Sci 2004;11:20-2.

Tsang KK, Kwong EW, Shing-Shun To T, Chung JW, Wong TK. A pilot randomized, controlled study of nanocrystalline silver, manuka honey, and conventional dressing in healing diabetic foot ulcer. Evid-Based Compl Alt Med 2017:1-15.

Jan WA, Shah H, Khan M, Fayaz M, Ullah N. Comparison of conventional pyodine dressing with honey dressing for the treatment of diabetic foot ulcers. J Postgrad Med Inst 2012;26:402-7.

Ur-Rehman E, Afzal MO, Ali A, Qureshi AR, Rashid M. Comparison between honey and povidone-iodine/normal saline dressing for management of Wagner’s grade s I and II diabetic foot ulcers. Pak J Med Health Sci 2013;7:1082-85.

Mukherjee R, Smanta S, Jha A, Srkar GP. A comparative study of effectiveness of honey and povidone iodine in healing of surgical wound. IJCMSR 2018;3:142-6.