<p>Honey Combination Therapies for Skin and Wound Infections: A Systematic Review of the Literature</p>

Abstract

Topical application of medical grade honey is recommended for the clinical management of wound infections. The suitability of honey as a wound healing agent is largely due to its antibacterial activity, immune modulatory properties, and biocompatibility. Despite the usefulness of honey in wound healing, chronic wound infections continue to be a global problem requiring new and improved therapeutic interventions. Several recent studies have investigated the effects of combining honey with other therapies or agents with the aim of finding more efficacious treatments. In this systematic review, the database PubMed was used to carry out a search of the scientific literature on the combined effects of honey and other therapies on antimicrobial activity and wound and skin healing. The search revealed that synergistic or additive antimicrobial effects were observed in vitro when honey was combined with antibiotics, bacteriophages, antimicrobial peptides, natural agents, eg, ginger or propolis and other treatment approaches such as the use of chitosan hydrogel. Outcomes depended on the type of honey, the combining agent or treatment and the microbial species or strain. Improved wound healing was also observed in vivo in mice when honey was combined with laser therapy or bacteriophage therapy. More clinical studies in humans are required to fully understand the effectiveness of honey combination therapies for the treatment of skin and wound infections.

Role of Honey in Advanced Wound Care

“…However, with the arrival of antibiotics, the use of honey gradually decreased. Nowadays, microbial drug-resistance has become an increasingly common concern, and honey has regained the scientific interest as an antibacterial agent [ 8 , 12 , 13 ]. Intrinsic characteristics of honey, such as high osmolarity, low water activity, and acidity, as well as some compounds, such as hydrogen peroxide, phenolic compounds, methylglyoxal, or bee defensin-1 peptide, directly affect the bacterial growth and survival [ 30 , 31 , 32 ].…”

“…Non-healing wounds, as well as burns, present an elevated risk of infection, which might increase morbidity and mortality derived from sepsis and inflammation in organs [ 13 ]. In addition, drug-resistant infections and wounds with biofilms are particularly difficult to treat, since bacteria do not respond to the therapy or are protected by a self-produced matrix of polysaccharide material [ 36 ].…”

“…Furthermore, due to its several antimicrobial components and its different antibacterial action mechanisms, the development of bacterial resistance to honey is unlikely [ 8 , 11 , 12 ]. Moreover, the wound-healing ability of honey is also related to its anti-inflammatory and antioxidant activity, as well as its capacity to promote re-epithelialization and angiogenesis and stimulate skin and immune cells [ 13 , 14 ]. All these mechanisms act together favoring the regeneration process of the damaged tissue.…”

Alternative Approaches for the Management of Diabetic Foot Ulcers

“…Its regenerative properties and low cost explain the increased interest in propolis for promoting chronic wound healing (Henshaw et al, 2014;Martinotti and Ranzato, 2015). To our knowledge, propolis alone has not been used in DFU, but a recent review summarized the effect of propolis with a combination of several antibiotics in skin problems including wounds (McLoone et al, 2020).…”

Fabrication and characterization of alginate/chitosan hydrogel combined with honey and aloe vera for wound dressing applications

“…In previous studies, due to the complexity of honey's combination, low concentrations of this substance have often been used in combination with several polymers. [22][23][24][25] Concentration optimization in this study was performed so that firstly, a simple polymer compound is used, and secondly, supplements are added to the compound in the highest possible concentration to have more benefits. According to recent researches, honey and Aloe vera have different effects at each concentration.…”