This review article presents a brief background on the historical use of honey in wound treatment, describes how honey is hypothesized to work on wounds and provides specific recommendations for using honey in clinical practice to treat wounds.

Excessive and/or indiscriminant use of antibiotics has led to the emergence of antibiotic resistant strains of bacteria. The inhibition of antibiotic resistant bacteria by honey has not been fully explored. Thus, the purpose of this study was to determine the sensitivity to honey of Gram-positive cocci in wounds and show that the inhibition of bacterial species by honey in not due exclusively to its osmolarity. Eighteen strains of methicillin-resistant Staphylococcus aureus (MRSA) and seven strains of vancomyacin-sensitive enterococci (VSE) (isolated from infected wounds) and 20 strains of vancomyacin-resistnant enterococci (VRE) (isolated from a hospital intensive care unit, hematology and cardiology wards) were exposed to manuka honey, a pasture honey, and an artificial honey. The results indicated that both honeys were significantly more effective in inhibiting MRSA, VSE, VRE than the honey analogue suggesting that honeys antibacterial properties are not exclusively due to its osmolarity. Sensitivity to the honey of VSE abd VRE showed no substantial differences indicating that honey may be effective in the treatment of wounds colonized by antibiotic-resistant bacteria.

The purpose of this study was to examine the efficacy of honey as a treatment of neonatal post-operative wound infection. Nine infants with large, open infected wounds that had failed to heal with conventional intravenous antibiotic treatment (and cleaning the wound with chlorhexidine 0.05% W/V in aqueous solution and fusidic acid ointment) were treated with 5-10 ml of commercial, unprocessed , non-pasteurized and non-irradiated honey. The dressing was changed twice daily and the appearance of the wound and surrounding tissues were recorded. All infants showed marked clinical improvement after 5 d of treatment and the wounds were closed, clean and sterile in all infants after 21 d of honey application. There were no adverse reactions to the treatment. The authors concluded that honey could be useful in the treatment of post-surgical wounds that are infected and do not respond to conventional systemic and local antibiotic treatment.

The purpose of this study was to determine the effects of three different honeys (manuka, pasture, and jelly bush) on the release of important inflammatory cytokines (e.g., tumour necrosis factor-alpha (TNF-a) and interleukin (IL)-1ß and IL-6.) involved in the would healing process using the monocytic cell line, MonoMac-6 (MM6). The three honeys, together with a sugar syrup control (artificial honey) were incubated with MM6 cells at a concentration of 1% (w/v) for 0-24h. Cell culture supernatants were tested using specific ELISA assays for TNF-a, IL-1ß, and IL-6. All honeys significantly increased the TNF-alpha, IL-1beta and IL-6 release from MM6 cells (and human monocytes) when compared with untreated and artificial-honey-treated cells (p <0.001). Of the three honeys, jelly bush produced the greatest release of each cytokine (which was significantly greater than the manuka and pasture-honey-treated cells, (p<0.001). The results of this study suggest that honey’s impact on wound healing may be related in part to the stimulation of inflammatory cytokines from monocytic cells.

A number of potential causes of the antimicrobial activity of honey have been postulated including, (1) high osmolarity, (2) acidity, (3) hydrogen peroxide, (4) and unidentified substances from certain floral sources. This study sought to further elucidate potential sources of the antimicrobial activity of honey. The antimicrobial activities of treefoil honey and a honey analogue (a sugar solution containing 46.5% fructose, 34% glucose, 1.5% sucrose, and 18% water) at different concentrations (i.e., different levels of dilution) towards 21 types of bacteria and 2 tyes of fungi were examined. Honey and the honey analogue demonstrated similar bacteriostatic activity when undiluted; however, honey demonstrated significantly greater bacteriostatic activity than the honey analogue when diluted (p < 0.05). Honey exhibited greater bactericidal activity than the honey analogue at all concentrations (p < 0.05) indicating the presence of other contributory causes of the antibacterial activities of honey. Only the honey demonstrated antifungal activity. Evaluation of the potential antimicrobial compounds in honey identified flavonoids, particularly caffeic acid and ferulic acid as the most likely contributors.