Honey and venous leg ulceration: a systematic review & randomised controlled trial

Abstract

Aims: To investigate the effect of honey on wound healing by conducting [1] a systematic review of trials of honey in wound care and [2] a randomised controlled trial of honey-impregnated dressings for the treatment of venous leg ulcers (the HALT trial). Systematic review: Method - The Cochrane Controlled Trials Register, AMED and LILACS were searched for controlled trials using honey for any type of patient with an acute or chronic wound. Honey manufacturers and researchers were contacted, citations scrutinised and the internet searched. Data from included studies were combined where studies were sufficiently alike. Findings - 18 trials were included. Honey significantly decreased healing time compared to conventional dressings for partial thickness burns (WMD -4.7 days, 95%Cl -5.1 to -4.3), but delayed healing time in comparison to early excision and skin grafting for mixed partial and deep thickness burns (WMD 25 days, 95%Cl 17.4 to 32.6). No significant effect was found for minor acute wounds or for honey compared to silver sulfadiazine in partial thickness burns. There were no trials of honey for treating venous leg ulcers. Randomised controlled trial: Method - The HALT trial was a pragmatic, open label randomised trial. Participants received either a manuka honey-impregnated calcium alginate dressing (n=187) or usual care (n=181) for 12weeks. Both groups received compression bandaging. The primary outcome was the proportion of participants with healed ulcers at 12 weeks. Secondary outcomes were time to healing, change in ulcer area, incidence of infection, adverse events, health-related quality of life and cost-effectiveness. Findings -104 participants in the honey-treated (55.6%) group and 90 (49.7%) in the usual care group healed at 12 weeks (absolute increase 5.9%, 95%Cl -4.3% to 15.7%, p=0.3). Time to healing was not significantly different between the groups (mean difference -1.8 days, 95%Cl -7.7 to 4.1, p=0.5), nor was change in ulcer area (mean difference 0.9cm2, 95%Cl -1.4cm2 to 3.2cm2, p=0.4)incidence of infection (absolute decrease 5.0%, 95%Cl -3.1% to 13.1%, p=0.2), ulcer recurrence (absolute increase 5.2%, 95%Cl -0.4% to 10.7%, p=0.1), or quality of life. The average cost of community-based treatment per participant was higher in the honey-treated group (NZ$862 versus NZ$795). More adverse events were reported in the honey-treated group (RR 1.3, 95%Cl 1.1 to 1.6, p=0.01). More participants reported pain as an adverse event when treated with honey (RR 2.5, 95%Cl 1.5 to 4.2, p=0.0001). Interpretation: Systematic review - Honey may be an effective treatment for partial thickness burns in comparison to conventional dressings. Honey does not appear to benefit healing in other acute wounds and may delay healing in mixed and partial thickness burns compared to excision and grafting. The HALT trial - Honey-impregnated dressings did not have any significant positive effect on venous ulcer healing and were more expensive than usual care. Participants treated with honey experienced more pain than control participants.