Essay On Honey As A Treatment For Bacterial Wound Infections: A Critical Assessment

Discuss How effective is honey at treating bacterial wound infections?
 

Historical Use of Honey as a Wound Treatment

Substantial amount of historical evidence reported that use of honey as a treatment for wound amongst ancient Egyptians as well as for the duration of the world wars by field nurse. After the penicillin discovery and subsequent antibiotic insurgence, honey became ignored as a treatment for wound. In the year 1999, in Australia, honey was recorded as a current medical preparation for the first time. This leads to the emergence of different honey based products like sterile manuka honey tubes, dressings, and ointments. However, these were underutilized and only used as a last resort. In contrast, current emergence of antibiotic resistance bacteria or superbug have changed this scenario. Antibiotics are become ineffective against bacteria in a terrifying rate and no new group of antibiotics have not been discovered in the last three decades. Along with these, creating new antibiotics are difficult and expensive task without any guarantee of success. This prompts researchers to look for alternative way like use of honey to treat wound infection. Honey has high acidity (pH varies from 3.4 -6.1) and osmolarity (Aw: 0.6) levels (Maddocks & Jenkins, 2013). Researchers believe that this is the reason behind honey’s antimicrobial activity as it leads to inhospitable environment for many microbes (Maddocks & Jenkins, 2013). Although, artificial honeys which imitates the sugar constituent of honey have inferior antimicrobial activity in comparison with the organic honeys. Not only bacteria, but honey is effective against viruses and fungi also. Studies have shown that fifty-eight strains of coagulase positive Staphylococcus aureus isolated from infected wound were detected as sensitive to honey (Maddocks & Jenkins, 2013). Furthermore, antibiotic resistant variant like methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci have found to be vulnerable against different types of honeys at 10 per cent concentration (w/v) and below (Maddocks & Jenkins, 2013). Eighteen isolated strain of MRSA and seven vancomycin resistant enterococci were amongst them. In most of the studies which investigated the mechanism of antimicrobial actions of honey used manuka honey as its sterile preparation has been commercially available. Revamil™ and manuka honey are only two honey variants commercially available which are registered as medical device (Maddocks & Jenkins, 2013). However, there is no academic evidence for any large scale clinical trial for honey as a treatment for wound although pre- prepared honey wound dressings or tube of pure honey has been registered as medical device. Therefore, in this critical assessment, article related to the research question ‘How effective is honey at treating bacterial wound infections?’ will be assessed.

Antimicrobial Properties of Honey

Article selection

For this critical assessment, five articles have been chosen. Three of them are review article and two of them are original research article. Focus have been given on the recent articles related to the topic. To this extent, all five articles were selected from the timeframe between 2013 and 2018.

Search database

The database that was used for the searching of the articles was ‘Google Scholar’ (https://scholar.google.co.in/). The custom range was used for the search by setting the parameters between 2013 and 2018.

Search keywords

Few keywords were used to get the articles relevant to the topic discussed in this critical assessment. Those keywords are: ‘Honey’, ‘treatment’, ‘bacterial’, and ‘infection’. 

Assessment and grading tool

After that the articles were assessed and graded on their merit. Assessment tool that was used in this article is Method for Evaluating Research and Guideline Evidence (MERGE) as mentioned by Rychetnik et al. (2002). For the MERGE assessment two different criteria was used, one is descriptive information about the review or study and another is evaluation criteria. Both of these criteria were assessed using various different parameters for example type of study, outcomes and implementation methods. On the other hand, for the grading of the articles, FORM evidence based clinical guidelines have been used (Hillier et al., 2011). Five grading parameters were used to grade and assess the studies and these are evidence base, consistency, clinical impact, generalisability, and applicability to Australian healthcare. To grade these five parameters, four grading mark have been used which are excellent, good, satisfactory, and poor.

Results

Method for Evaluating Research and Guideline Evidence (MERGE) assessment tool was used to assess the articles. Assessment of the articles have been provided below:

Assessment of the article 1:

Grading assessment of the five chosen articles have been described below:

To summarize the above result section, it can be inferred that all the review and studies were investigating the effect of honey as topical treatment and its efficacy in wound treatment and antimicrobial activity due to the recent rise drug resistant microbes or superbug.  Jull, Walker & Deshpande (2013) have reviewed the use of honey as a topical treatment and its use in treating wounds. They have concluded that honey might be effective in comparison with conventional dressings but there is considerable amount of uncertainty regarding the acceptability and replicability of this evidence. On the other hand, Maddocks & Jenkins (2013) have investigated the merit of honey as a solution to the growing problem of antimicrobial resistance. They have reported in their study that manuka honey have strong antimicrobial property. On the contrary, Eteraf-Oskouei & Najafi (2013) have investigated honey in a broad view reported its traditional and modern uses. Similar like previous two reviews, they have also reported various benefits of honey which can be used to treat various human diseases. Boekema & Ulrich (2013) have used honey based gel to treat the bacterial infection of in vitro burn wounds. In their study, they reported that, honey based gel can be effective alternative for traditional treatments and can be applied in higher frequency. Additionally, Noori et al., (2013) have investigated the differences in various honey composition along with their antimicrobial activities towards drug resistant bacteria and pathogenic fungi. Similar like Boekema & Ulrich (2013), they have also suggested that honey can be used as a alternative treatment methods against drug resistant microbes.  However, from the assessment and grading described in result section, it can be seen that quality of the all the paper are not same and Jull, Walker & Deshpande (2013) have published the highest quality of research as its secured the highest grading regarding the parameters. Papers published by Boekema & Ulrich (2013) and Noori et al., (2013) are also closely behind in quality. All of the paper reported the effectiveness of honey as a substitute to antimicrobial treatment and there is already pre-prepared honey wound dressings is available in the market. Therefore, honey can be implemented as a treatment to various hospitals and treatment centres as alternative to reduce the risk of drug resistant microbes. Multiple studies have reported to the effectiveness of the honey, but very little or no researches have been dedicated to large scale, robust clinical trials of honey in healthcare. Further research is needed in this area to reduce gap or limitation whether honey can be used in healthcare as topical treatment.

Conclusion

Therefore, from the above discussion, it can be concluded that honey has the potential to be used as topical treatment to battle bacterial wound infections. Multiple researches have been performed in this area and all of them reported that honey has antimicrobial activity. However, effectiveness of the honey can be varying on the type and location of the harvested area. Additionally, there is no evidence of large scale clinical trial of honey as an alternative treatment despite few honey wound dressing available commercially as registered medical device. Hence, further research and government support is needed to make honey as an alternative treatment for bacterial wound infections 

References

Boekema, B. K. H. L., Pool, L., & Ulrich, M. M. W. (2013). The effect of a honey based gel and silver sulphadiazine on bacterial infections of in vitro burn wounds. Burns, 39(4), 754-759.

Eteraf-Oskouei, T., & Najafi, M. (2013). Traditional and modern uses of natural honey in human diseases: a review. Iranian journal of basic medical sciences, 16(6), 731.

Hillier, S., Grimmer-Somers, K., Merlin, T., Middleton, P., Salisbury, J., Tooher, R., & Weston, A. (2011). FORM: an Australian method for formulating and grading recommendations in evidence-based clinical guidelines. BMC medical research methodology, 11(1), 23.

Jull, A. B., Walker, N., & Deshpande, S. (2013). Honey as a topical treatment for wounds. Cochrane Database Syst Rev, 2(2).

Maddocks, S. E., & Jenkins, R. E. (2013). Honey: a sweet solution to the growing problem of antimicrobial resistance?. Future microbiology, 8(11), 1419-1429.

Noori, A. L., Al Ghamdi, A., Ansari, M. J., Al-Attal, Y., Al-Mubarak, A., & Salom, K. (2013). Differences in composition of honey samples and their impact on the antimicrobial activities against drug multiresistant bacteria and pathogenic fungi. Archives of medical research, 44(4), 307-316.

Rychetnik, L., Frommer, M., Hawe, P., & Shiell, A. (2002). Criteria for evaluating evidence on public health interventions. Journal of Epidemiology & Community Health, 56(2), 119-127.