Medical-Grade Honey as an Alternative to Surgery

A Case Series

Jennifer Bayron, MD; Kathy Gallagher, DNP, APRN, FNP, FACCWS; Luis Cardenas, DO, PhD


Wounds. 2019;31(2):36-40. 

In This Article


Operative debridement has been the foundation of wound management, but with the increasing number of complex patients and wounds, alternative options need to be investigated. Active Leptospermum honey is a viable therapy for wound management in patients who have contraindications for operative debridement or request conservative management. However, operative debridement should remain a tenet of wound management in appropriate patients. In the present case series, the authors reported 12 patients who either were not operative candidates secondary to their medical comorbidities or did not wish to undergo operative debridement for personal reasons; all patients achieved wound closure with the assistance of ALH.

Medical-grade honey is gamma irradiated to allow for sterilization without loss of its antibacterial properties.[5] Honey marketed for oral intake is heat treated to allow for safe ingestion, but in this process, the antibacterial effects of the honey are lost.[5] The Unique Manuka Factor (UMF) is a rating scale for the antibacterial effects of honey.[5] Medical-grade honeys have high UMF, indicating that even when diluted, medical-grade honeys maintain antibacterial properties.[5]

The high sugar content not only creates an osmotic gradient resulting in bacterial dehydration but also hinders bacterial growth.[6] It further forms low levels of hydrogen peroxide that are toxic to bacteria but not to healthy tissue.[6] This is very important in elderly and neonate populations, as both populations are immunocompromised to a varying degree, making them more susceptible to infection.

Second, ALH has anti-inflammatory properties. Although not completely understood, studies have demonstrated ALH stimulation of monocytes in cell culture resulting in the release of many cytokines involved in wound healing and regulation of the inflammatory cascade.[2] These properties have been reported[2] to decrease edema and pain while allowing increased blood flow to the area with the needed mediators for wound healing. Further, it has autolytic debridement properties stemming from activation of tissue proteases and the osmotic gradient created, which removes the wound of debris and slough.[2] These properties are significant if operative debridement is not undertaken. The alternative therapy needs to provide debridement properties and support wound healing.

In a case series by Blaser et al,[7] the effects of medical-grade honey on wounds colonized or infected with Methicillin-resistant Staphylococcus aureus (MRSA) were investigated. Their case series looked at 7 patients with dissimilar wounds that were colonized or acutely infected with MRSA, confirmed by wound culture swab.[7] All patients demonstrated negative wound swabs for MRSA at follow-up; however, the follow-up interval was not standardized, so they were unable to determine the length of time needed for eradication. The range of follow-up negative tests was 6 to 100 days.[7] All patients went on to achieve wound closure, with only 1 patient requiring discontinuation of therapy secondary to pain but required no further debridement, which was thought to be attributed to the ALH. A study by Baghel et al[6] compared the effects of honey versus silver sulfadiazine in burn wounds.[6] All patients had wound cultures taken on admission and subsequently every 7 days until their wounds were healed.[6] All patients with first-degree burns were treated with 5 days of intravenous (IV) antibiotics, while those with second-degree burns were given 10 days of IV antibiotics.[6] The average duration of healing was significantly less in the honey group compared with the silver sulfadiazine, and ultimately, 81% of the wounds treated with honey went on to heal compared with 37% of the silver sulfadiazine.[6] Further, patients in the honey group had negative wound cultures as early as 7 days, with all patients having sterile wounds by day 21; only 36.5% of the silver sulfadiazine wounds became sterile by day 21.[6]

Mohr et al[9] presented 3 neonatal patients treated with ALH. In 1 case, they[9] described a neonate with a complicated neonatal intensive care course including sepsis, vasopressor requirements, nutrition from hyperalimentation, and steroid therapy. The neonate developed ischemia of the left toes that was treated conservatively with ALH to heal the wound, thus preventing amputation.[9] This case series demonstrated the difficulty of treating wounds in the neonate population and the need for consideration of alternative therapies for this patient population. Like neonatal patients, elderly patients present a challenge for wound healing and necessitate alternatives to aggressive operative debridement.