What's medical-grade honey? What are its uses?-L.L., FLA.

Kimberley Oropeza, BSN, RN, WCC, replies: Several civilizations used honey to treat wounds over the course of 4,000 years.1 It lost conventional popularity after the discovery of antibiotics in the 20th century, but practitioners are now giving this ancient remedy another look due to the need for effective and economical products that fight infection and limit antibiotic resistance.1

Honey, a hyperosmolar substance produced by bees, is about 20% water and 80% sugar. It also contains enzymes, amino acids, carbohydrates, vitamins, and organic acids. The exact composition varies greatly depending on the location and type of plant from which the bees collected nectar.1

Medical-grade honey has been standardized through gamma irradiation, filtration, and lab-controlled conditions, ensuring it's free from contaminants. The honey most commonly in use today comes from bees that collect pollen from tea trees in New Zealand and Australia.2 Also known as manuka honey, it has the highest level of antibacterial activity of all honey.2

Honey is currently used to fight bacterial and fungal infections, promote autolytic debridement, and control malodorous wounds.2 It has many properties that contribute to wound healing. It kills Gram-positive and Gram-negative pathogens as well as some fungi and yeasts. This makes it useful against various organisms, including drug-resistant organisms such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus.2 Honey has been particularly successful in treating wounds resistant to traditional antibiotics.3 The acidic properties of honey keep the pH relatively low (3.5 to 6), which inhibits bacterial growth and promotes healing in alkaline wounds that are otherwise difficult to heal.4

Honey is also an effective deodorizer of malodorous wounds through the bacteria's consumption of sugar. When bacteria in the wound metabolize amino acids, materials that cause foul odors, such as ammonia, amines, and sulfur, are created. Bacteria consume the glucose in the honey instead of the amino acids, decreasing the production of foul-smelling substances.3

The osmotic property of honey draws fluid out of the wound, creating an anti-inflammatory response. Honey promotes autolytic debridement, which produces a moist healing environment, enabling healing.3

Currently, medical-grade honey is indicated for acute and chronic wounds, including surgical wounds, abrasions, first- and second-degree burns, pressure ulcers, and leg and foot ulcers. It's mostly indicated for sloughy, necrotic, malodorous wounds.4

Several products are available depending on the type of wound. Products that come in a tube can be applied directly to the wound, which requires a secondary dressing. Honey-impregnated dressings include calcium alginate, nonadherent gauze, gel sheets, hydrogels, and mesh in various shapes and sizes. Dressing choice is dependent on the degree of moisture present or needed in the wound.

Some challenges and precautions must be considered:

* Honey that comes in a tube can be difficult to apply because of its fluid nature and may not adhere well to a wound bed that may already be moist.

* The honey should stay within the wound border to prevent maceration of surrounding skin.

* Honey dressings and treatments are contraindicated in people known to be allergic to bee venom or sensitive to honey.

* Patients with diabetes using honey products need to closely monitor their blood glucose levels.

* Some patients have reported a transient burning sensation due to the product's low pH that usually subsides after about 30 minutes. If it continues, discontinue use of the product. No other allergic reactions or sensitivities have been reported.

* Unregulated, unlicensed honey is contraindicated for use in wounds due to potential contamination from pesticides and bacteria such as Clostridium botulinum.2

Due to the rise of antibiotic resistance, honey is getting a second look for wounds that are difficult to heal using more conventional remedies. This therapy is a great addition to wound care management strategies.5

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