References

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Blair S. An historical introduction to the medicinal use of honey. In: Cooper R.A., Molan P., White R.J. (eds). UK, Aberdeen: HealthComm; 2009

Cooper R.A. Honey for wound care in the 21st century. J Wound Care. 2016; 25:(9)544-552

Allen K.L., Molan P.C., Reid G.M. A survey of the antibacterial activity of some New Zealand honeys. J Pharm Pharmacol. 1991; 43:(12)817-822

Carter D.A., Blair S.E., Cokcetin N.N. Therapeutic manuka honey: no longer so alternative. Front Microbiol. 2016; 7 https://doi.org/10.89/fmicb.2016.00569

Molan P.C. The role of honey in the management of wounds. J Wound Care. 1999; 8:(8)415-418

Cooper R.A., Molan P.C. Honey in wound care. J Wound Care. 1999; 8:(7)

Cooper R.A., Molan P.C., Harding K.G. Antibacterial activity of honey against strains of Staphylococcus aureus from infected wounds. J R Soc Med. 1999; 92:(6)283-285

Topham J. Sugar for wounds. J Tissue Viability. 2000; 10:(3)86-89

Yoon Y.M., Newlands C. Quality standards of medical grade Manuka honey. In: White R.J., Cooper R.A., Molan P (eds). : Wounds UK; 2005

Molan P., Hill C. Quality standards for medical grade honey. In: Cooper R.A., Molan P., White R.J. (eds). Aberdeen: HealthComm UK; 2009

Packer J.M., Irish J., Herbert B.R. Specific non-peroxide antibacterial effect of manuka honey on the Staphylococcus aureus proteome. Int J Antimicrob Agents. 2012; 40:(1)43-50

Rabie E., Serem J.C., Oberholzer H.M. How methylglyoxal kills bacteria: An ultrastructural study. Ultrastruct Pathol. 2016; 40:(2)107-111

Molan P., Rhodes T. Honey: a biologic wound dressing. Wounds. 2015; 27:(6)141-151

Jenkins R., Wootton M., Howe R., Cooper R. Susceptibility to manuka honey of Staphylococcus aureus with varying sensitivities to vancomycin. Int J Antimicrob Agents. 2012; 40:(1)88-89

Jenkins R.E., Cooper R. Synergy between oxacillin and manuka honey sensitizes methicillin-resistant Staphylococcus aureus to oxacillin. J Antimicrob Chemother. 2012a; 67:(6)1405-1407

Biglari B., vd Linden P.H., Simon A. Use of Medihoney as a non-surgical therapy for chronic pressure ulcers in patients with spinal cord injury. Spinal Cord. 2012; 50:(2)165-169

Biglari B., Moghaddam A., Santos K. Multicentre prospective observational study on professional wound care using honey (Medihoney™). Int Wound J. 2013; 10:(3)252-259

Okhiria O.A., Henriques A., Burton N.F. Honey modulates biofilms of Pseudomonas aeruginosa in a time and dose dependent manner. J Api Prod ApiMed Sci. 2009; 1:(1)6-10

Maddocks S.E., Jenkins R.E., Rowlands R.S. Manuka honey inhibits adhesion and invasion of medically important wound bacteria in vitro. Future Microbiol. 2013; 8:(12)1523-1536

Maddocks S.E., Lopez M.S., Rowlands R.S., Cooper R.A. Manuka honey inhibits the development of Streptococcus pyogenes biofilms and causes reduced expression of two fibronectin binding proteins. Microbiology. 2012; 158:(3)781-790

Lu J., Turnbull L., Burke C.M. Manuka-type honeys can eradicate biofilms produced by Staphylococcus aureus strains with different biofilm-forming abilities. Peer J. 2014; 2

Majtan J., Bohova J., Horniackova M. Anti-biofilm effects of honey against wound pathogens Proteus mirabilis and Enterobacter cloacae. Phytother Res. 2014; 28:(1)69-75

Jenkins R., Burton N., Cooper R. Manuka honey inhibits cell division in methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother. 2011; 66:(11)2536-2542

Boateng J., Diunase K.N. Comparing the antibacterial and functional properties of Cameroonian and manuka honeys for potential wound healing-have we come full cycle in dealing with antibiotic resistance?. Molecules. 2015; 20:(9)16068-16084

Henriques A., Jackson S., Cooper R., Burton N. Free radical production and quenching in honeys with wound healing potential. J Antimicrob Chemother. 2006; 58:(4)773-777

Al-Maaini R., Cooper R.A. Multiple inhibitory effects on mutlidrug-resistant Gram negative bacteria in vitro. J Applied Microbiol. 2016;

Jenkins R., Cooper R. Improving antibiotic activity against wound pathogens with Manuka honey in vitro. PLoS One. 2012b; 7:(9)

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Hard-to-heal wounds
Wound dressings

Manuka honey in wound management: greater than the sum of its parts?

02 October 2017
Review
02 October 2017
Volume 1 · Issue 4

Abstract

Few involved in wound care will have escaped the considerable interest which has been generated by the resurgence in honey. Equally, there will be many clinicians around the globe who are wondering why all the fuss, as they will have been using honey all along. However, even with the advent of ‘medical-grade’ honey, combined with considerable research into the numerous potential modes of action, there remains a lingering scepticism regarding the value of honey as a justified, modern intervention in wound care. The purpose of this brief review is to summarise the ongoing chemical, biochemical and microbiological research and to correlate it with clinical outcomes. The purpose being to present the enquiring clinician with an evidence summary with which clinical choices may be made. While much of the early research was into generic honeys, one particular source, manuka, appears especially effective, and as such this has been the focus of recent studies.

Honey has been used to treat wounds for millennia.1,2 Indeed, until the modern age of evidence-based medicine, honey was so highly regarded as a treatment for wounds that it was accepted as a first-line intervention. It is, however, the scientific and clinical focus on honey which has come about in the past 30 years that has led to the classification of medical-grade honey and the commercial availability of highly regulated products.

The literature includes reports on numerous honeys, from different floral sources, for in vitro antimicrobial activity in particular. Due to the pioneering work of the late Peter Molan3 in New Zealand over the past 25 years, it has emerged that of the range of honeys tested, those from one source, manuka, has particularly high antimicrobial activity.4 Subsequently many other reports have supported and clarified this activity this is summarised in a review by Carter et al.5 It is owing to a series of seminal articles by Molan6 and colleagues7,8 in 1999 that the modern approach to honey in wound can be traced. Until that time there had been debate as to the clinical effects of honey being largely osmotic.9 Molan, based upon the considerable evidence available, identified a number of distinct actions of honey (primarily manuka) on the wound, namely:

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honey
wound care
anti-inflammatory
antimicrobial
debridement
manuka