Leptospermum Honey Research Articles

Leptospermum honey – A medicinal wonder for periodontal health

Antibacterial therapy has always been included effectively in the regimen of periodontitis. The inability to access periodontal disease-causing organisms within periodontal pockets has limited the effectiveness of mechanical plaque removal and the use of antibacterial agents. The drug’s systemic administration results in therapeutic concentrations at the site of infection, but only in the short term, necessitating repeated dosing over longer periods. Topical antibiotics have been studied for their ability to overcome the limitations of conventional therapy. It is of interest to use sustained release formulations to deliver antimicrobial agents to the site of infection (periodontal pocket). At much lower doses, these products provide long-term treatment at the site of infection. From time immemorial, honey is not only considered as a natural sweetener but is also used for its healing power. It is used in traditional folk and tribal medicines and 93% of the consumers of honey use it for its medicinal value. Active Leptospermum Honey (ALH) is the most researched medical grade honey for wound and burn treatment. This article documents the efficacy of ALH as a topical drug delivery system in patients with chronic periodontal disease.

Management of Extravasation Injury in Infants: A Systematic Review of Clinical Trials

Context: One of the common procedures in the neonatal intensive care unit (NICU) is the insertion of a venous catheter, and one of the most important and serious complications is extravasation, which is a leading cause of death in hospitalized infants. Based on the researcher’s experience in the NICU and the necessity of extravasation injury management in infants, this review study focused on extravasation injury management in infants. Methods: The literature was searched in ProQuest, Scopus, and PubMed databases using the terms “extravasation” OR “vascular leakage” OR “Peripheral Infiltration” AND “Neonatal” OR “Newborn” OR “Infants” OR “NICU.” The search procedure was performed in the title, abstract, and full text of articles published in English from 2000 to 2022. Results: In the initial search, 3414 articles were extracted. After removing the duplicates and searching the titles and abstracts of the articles, 132 related articles were found, and their full texts were studied. Finally, 20 articles entered the final analysis stage. Nine case report studies, five case series studies, three clinical trials, and three retrospective review studies were found. The results showed that various treatment methods are available, including elevating limbs, pain relief, hot and cold compresses, flush-out technique with saline, dressings (hydrocolloid, hydrogel, and hydrocellular foam), medications (2% nitroglycerin ointment and subcutaneous administration of hyaluronidase and phentolamine), and new methods such as amniotic membranes, omega-3-rich fish skin (Kerecis), active leptospermum honey (ALH), PRP, and surgical removal. Conclusions: Despite many medical advances, there is still no specific approach to managing extravasation in infants. The ideal approach to extravasation injuries is still to prevent them initially. The best next step is to minimize the damage using antidotes or hyaluronidase. Using saline to remove the solution and physically minimize damage can be useful. Thus, more studies are needed to address extravasation management in infants.

The rapid evaporative ionisation mass spectrometry metabolite fingerprint of Leptospermum honey is strongly associated with geographic origin

There is debate about whether the honey from Leptospermum scoparium nectar in New Zealand is substantially different to honey from Leptospermum spp nectar from Australia; many Leptospermum honeys have high amounts of the antibacterial compound methylglyoxal (MGO) but are known to differ in their amounts of other metabolites. Retail honey samples labelled as ‘mānuka’, manuka, or ‘tea tree’ honey sourced from New Zealand (n = 34) and Australia (n = 35), were measured using laser assisted-rapid evaporative ionisation mass spectrometry (REIMS) in positive and negative ionisation modes, with 1637 and 1744 molecular features detected, respectively. Country of origin was strongly reflected in the REIMS fingerprints irrespective of similarity of methylglyoxal, with >50% of detected features differing between New Zealand and Australian-sourced honey. Combined REIMS features in negative ionisation mode correlated strongly with current molecular markers of mānuka honey quality (r2 > 0.9). Leptospermum honey from New Zealand and Australia have distinct molecular fingerprints, potentially due to evolutionary and genomic differences between the predominant Leptospermum species, bees, environment and honey processing.

Active Leptospermum Honey as a Local Drug Delivery Agent in patients with Chronic Periodontitis: A Clinico-Biochemical Study

Background: Antibacterial agents have always been the part and parcel in the treatment of periodontal infection. One such known agent is Active Leptospermum Honey (ALH) which has been the most studied species of medical grade honey used for the treatment of wounds and burns. Therefore, this study revolves around evaluating the efficacy of active leptospermum honey as a local drug delivery (LDD) agent on probing pocket depth (PPD), relative attachment level (RAL), and periodontal pocket pH. Materials and Methods: Based on the study's inclusion and exclusion criteria, a total of 100 sites with probing pocket depth of ≥ 5mm in posterior region will be selected. The sites will be grouped as: Test Group: 50 sites, Control Group: 50 sites, following the assessment of baseline clinical and biochemical parameters. At the baseline appointment, each patient received full mouth scaling and root planning (SRP). They were called back after 48 hours. Following the assessment of biochemical parameters by using pH test paper strips, MEDIHONEY® was placed as a local drug delivery (LDD) agent in test sites. In control sites only SRP was done. Patients were recalled after 30 days following LDD to reassess only gingival index, plaque index and biochemical parameters. Patients were recalled at 90 days following LDD for the reassessment of all clinical and biochemical parameters. Results: Plaque and gingival inflammation reduced in both groups but test group showed more reduction. Pocket depths were reduced significantly in test site. There was significant pH reduction in test sites. Clinical attachment level was also seen to be improved in the sites which were tested. Conclusion: When administered locally, Active Leptospermum Honey demonstrated lessening of PPD, gingival index (GI), and plaque index (PI), as well as higher levels of clinical attachment (CA).

Potential distribution of Leptospermum species (Myrtaceae) in Australia for bioactive honey production purposes

ABSTRACT The genus Leptospermum (Myrtaceae) is widespread in Australia and contains several species that are of increasing interest to produce bioactive honey. Here, we used the Maxent algorithm to investigate bioclimatic, climatic, and soil variables as predictors for potential distributions of seven Leptospermum species that have been identified as useful for bioactive honey production in Australia (L. lanigerum, L. liversidgei, L. nitens, L. polygalifolium, L. scoparium, L. speciosum, and L. whitei). Bioclimatic and climatic variables, mainly those related to moist conditions, were the best predictors for the distribution of the species. Leptospermum lanigerum and L. scoparium were suitable species in areas in southwestern Australia and Tasmania, while L. polygalifolium was suitable for eastern Australia. For L. nitens, appropriate areas were found only in western and southern regions, whereas only border ranges in Queensland and New South Wales were considered suitable for L. liversidgei, L. speciosum, and L. whitei. Notably, the latter areas were identified as a potential ‘hotspot’ for Leptospermum species. Our study can assist the incipient Leptospermum honey industry in Australia in identifying suitable local species and the local maintenance requirements for the species chosen.

Use of Honey Versus Standard Care for Hospital-Acquired Pressure Injury in Critically Ill Children: A Multicenter Randomized Controlled Trial.

To examine if the use of honey (medicated) for dressing is superior to standard care in terms of time to complete wound healing in stages 1-3 of pressure injuries in children admitted to the PICU. Multicenter, open-label, parallel-group, randomized trial. Tertiary-care PICU from August 2017 to January 2019. Critically ill children, 2 months to 17 years old, who developed pressure injury (stages 1-3) were included; those on more than two inotropes or with signs of acute wound infection or wounds with greater than 5 cm diameter or known allergy to honey were excluded. Children were randomized to receive either medicated honey dressing or standard (routine) wound care for the management of their pressure injury. The primary outcome was the time to complete wound healing. Manuka or active Leptospermum honey dressing/gel was used in the intervention group. Enrolled children were followed up until death or discharge from the hospital. A total of 99 children were enrolled: 51 in the intervention group and 48 in the standard care group. Baseline characteristics, including the nutritional status, were comparable between the groups. The most common sites of injury were bony prominences at face mask contact points. The median time to complete healing was 7 days (95% CI, 6-7 d) versus 9 days (7-10 d) in the intervention and standard care groups, respectively (p = 0.002; log-rank test). At any random time, children in the intervention group were about 1.9-fold more likely to have their pressure injury completely healed than those in the standard care group (hazard ratio 1.86; 95% CI, 1.21-2.87). There were no allergic reactions or secondary wound infections in the intervention group. The use of medicated honey dressings decreased the time to wound healing in critically ill children with pressure injuries. There were no allergic reactions or secondary bacterial infections in any of these children.

The association of Leptospermum honey with cytokine expression in the sinonasal epithelium of chronic rhinosinusitis patients.

ObjectiveTo identify the differences in cytokine expression between sinonasal tissue from patients treated with Leptospermum (Manuka) honey (LH) irrigation versus normal saline irrigation twice-daily for twelve weeks following sinus surgery (FESS).MethodsForty-six CRS patients were recruited. Sinus tissue biopsies were collected during FESS and then at 5 and 12 weeks postoperatively during the course of treatment. A multi-plex cytokine assay quantified the abundance of 17 cytokines in biopsied tissue. Cytokine expression fold-change was analyzed between each time point using a robust linear regression model and compared between the two treatment groups.ResultsCompared to the saline irrigation group, five cytokines were differently expressed (CI = 95%) in sinonasal tissue obtained from subjects in the LH irrigation group during the 12-week treatment period. Cytokines IL-6 (P = 0.0400), IL-8 (P = 0.0398), MCP-1 (P = 0.0284), and MIP-1β (P = 0.016) were significantly increased in the LH irrigation group compared to the saline irrigation group. IL-13 was significantly increased in the saline irrigation group compared to the LH group (P = 0.0086).ConclusionLH may potentially act to modulate the expression of IL-6, IL-8, IL-13, MCP-1 and MIP-1β in sinonasal tissue.

Natural products show diverse mechanisms of action against Clostridium difficile.

To investigate the mechanisms of action of natural products with bactericidal (cinnamon root powder, peppermint oil, trans-cinnamaldehyde, menthol and zingerone) or bacteriostatic (fresh garlic bulb extract, garlic clove powder, Leptospermum honey and allicin) activity against two Clostridium difficile strains. Bactericidal products significantly reduced intracellular ATP after 1h (P≤0·01), quantified using the BacTiter-Glo reagent, and damaged the cell membrane, shown by the leakage of both 260-nm-absorbing materials and protein, and the uptake of propidium iodide. Bacteriolysis was not observed, determined by measuring optical density of treated cell suspensions at 620-nm. The effect of three bacteriostatic products on protein synthesis was quantified using an Escherichia coli S30 extract system, with Leptospermum honey (16% w/v) showing significant inhibition (P<0·01). Lastly, no products showed elevated minimum inhibitory concentrations against antimicrobial-resistant C. difficile, determined by broth microdilution. Cytoplasmic membrane damage was identified as a mechanism of action that may contribute to the activity of several natural products against C. difficile. This study describes the possible mechanisms of action of natural products against C. difficile, yet the efficacy invivo to be determined.

Dihydroxyacetone Production in the Nectar of Australian Leptospermum Is Species Dependent.

This study is the first large-scale survey of the presence of dihydroxyacetone (DHA) in the nectar of the Australian Leptospermum tree species. The work undertaken supports the growing global demand for bioactive Leptospermum honey. Leptospermum honey derived from L. scoparium in New Zealand, also referred to as Ma̅nuka honey, has a reputation for wound-healing and antimicrobial properties, which is based on its methylglyoxal (MGO) content. High-DHA nectar correlates to high-MGO honey, but not all Leptospermum species produce DHA in their nectar. This study investigates 55 of the 84 Leptospermum species native to Australia for their DHA-producing capability, with the DHA to total sugar (DHA:Tsugar) ratio of nectar samples determined by HPLC-PDA. DHA:Tsugar ranged from nondetectable in L. laevigatum, L. coriaceum, and L. trinervium to >16 000 mg/kg in L. speciosum and L. whitei. High-DHA Leptospermum species were identified for beekeepers to target for honey production and plantation development.

Treatment of Dehisced, Thoracic Neonatal Wounds With Single-Use Negative Pressure Wound Therapy Device and Medical-Grade Honey: A Retrospective Case Series.

The purpose of this study was to report on our experience with a portable, single-use negative pressure wound therapy device used in combination with activated active Leptospermum honey (ALH) in the treatment of colonized or infected, dehisced, thoracic wounds in neonates with complex congenital heart disease. Retrospective, descriptive study. We reviewed medical records of 18 neonates and reported on findings from 11; the remaining 7 were not included secondary to incomplete records, transfer to a different institution prior to wound healing, or death. The median age of our patients was 12 days (range, 2 days to 5 weeks); their mean gestational age was 34 weeks. All of the neonates had acquired postoperative wound dehiscence that were colonized or infected and were treated in the neonatal intensive care unit (NICU) at Cohen Children's Medical Center (New Hyde Park, New York), a regional perinatal center with a level 4 NICU. Wound cultures were obtained on all patients prior to treatment commencement. All cultures were repeated on day 4 of treatment. Systemic antibiotics were administered as necessary. No complications were observed related to the use of negative pressure wound therapy device and ALH. All patients were followed until discharge home or transfer to another facility. The pain scores during placement and removal were acceptable (between 1 and 3; median = 2) using the Neonatal Infant Pain Scale. Staff and parents indicated that the combination of ALH and the negative pressure wound therapy device did not interfere with daily care and parental bonding. Use of ALH and a single-use negative pressure wound therapy device was successful in this series of 11 neonates with complex congenital heart disease.

Comparing active Leptospermum honey dressing with conventional dressing in skin graft donor sites

Background: Active Leptospermum honey has non-peroxide antibacterial and anti-inflammatory effects, rendering it suitable for wound healing. Leptospermum honey is endemic in New Zealand belonging to the manuka bush (Leptospermum scoparium). The objective of the present research was to compare the efficacy of manuka honey dressing with conventional dressing regarding skin graft donor sites following a burn injury.Methods: This study was carried out in the department of surgery, Iran University of Medical Sciences, Tehran, Iran. It is a noncontrolled prospective trial, and an open-label study, analyzing Leptospermum honey and conventional dressing for the treatment of donor site areas for skin grafts. Data were collected from 15 eligible patients with burn wound. Two independent donor sites were formed, one of which was treated with active Leptospermum honey dressing and the other covered through the conventional method. Further collected was information regarding subjects’ demographics, self-reported pain (VAS scale), wound surface areas and bacterial wound culture.Results: In the treatment of skin graft donor sites, honey proved to be less painful compared with the conventional group (P=0.001). Three and seven days following treatment, a significant decrease was observed in the mean wound surface areas in the honey group (P=0.001). There was no significant difference between honey and conventional dressings with regards to the rate of infection (20% in honey dressing versus 40% in conventional group; P=0.068).Conclusions: Active Leptospermum honey dressing accelerates the healing process, decreases pain and has antimicrobial activity and can be used for care of skin graft donor sites.

Novel Use of Active Leptospermum Honey for Ringed Fixator Pin Site Care in Diabetic Charcot Deformity Patients.

Open reduction with external fixation (OREF) utilizing fine wire ringed fixators for correction of Charcot deformity has gained popularity over the past decade. Pin site infections are a well-documented complication of external fixation as well as a driver of escalating health care costs. We aimed to demonstrate the safety and efficacy of a novel method of pin site care utilizing active Leptospermum honey-impregnated dressings (MediHoney) in diabetic patients undergoing deformity correction with OREF. Twenty-one diabetic patients with Charcot deformities of the lower extremity were prospectively enrolled and followed for pin site complications following OREF for deformity correction. Active Leptospermum honey dressings were applied at metal-cutaneous interfaces at the end of the OREF procedure and replaced weekly for a total of 8 weeks. Patients were monitored for pin site infections from the time of surgery until external fixator removal. Sixteen consecutive patients receiving standard OREF for Charcot deformities were evaluated retrospectively to serve as a control group. Of the 21 enrolled patients, 19 underwent OREF and followed up throughout the study period. Treated patients had a mean age of 58.5 years and mean body mass index measuring 33.3 kg/m2 as documented prior to surgery. The 15 patients with hemoglobin A1c labs drawn in the 3 months preceding surgery averaged 7.5. Fixators were removed at an average of 12.1 weeks after adequate bony healing. Of the 244 pin sites in 19 patients, 3 pin sites (1.2% of pins) in 2 patients (10.5% of patients) showed evidence of superficial infection. All infections resolved with oral antibiotics. Infection rates were significantly reduced when compared to the standard care control group. Pilot data in a prospectively collected case series demonstrate safety and efficacy of active Leptospermum honey-impregnated dressings when used for fine wire ringed fixator pin site care in diabetic Charcot deformity patients. Further investigation in the form of a prospective randomized controlled study is warranted to demonstrate the potential value of this novel intervention. Level IV.

The Antibacterial Activity of Australian Leptospermum Honey Correlates with Methylglyoxal Levels.

Most commercially available therapeutic honey is derived from flowering Leptospermum scoparium (manuka) plants from New Zealand. Australia has more than 80 Leptospermum species, and limited research to date has found at least some produce honey with high non-peroxide antibacterial activity (NPA) similar to New Zealand manuka, suggesting Australia may have a ready supply of medical-grade honey. The activity of manuka honey is largely due to the presence of methylglyoxal (MGO), which is produced non-enzymatically from dihydroxyacetone (DHA) present in manuka nectar. The aims of the current study were to chemically quantify the compounds contributing to antibacterial activity in a collection of Australian Leptospermum honeys, to assess the relationship between MGO and NPA in these samples, and to determine whether NPA changes during honey storage. Eighty different Leptospermum honey samples were analysed, and therapeutically useful NPA was seen in samples derived from species including L. liversidgei and L. polygalifolium. Exceptionally high levels of up to 1100 mg/kg MGO were present in L. polygalifolium honey samples sourced from the Northern Rivers region in NSW and Byfield, QLD, with considerable diversity among samples. There was a strong positive relationship between NPA and MGO concentration, and DHA was present in all of the active honey samples, indicating a potential for ongoing conversion to MGO. NPA was stable, with most samples showing little change following seven years of storage in the dark at 4°C. This study demonstrates the potential for Australian Leptospermum honey as a wound care product, and argues for an extension of this analysis to other Leptospermum species.

Objective and subjective scar aesthetics with topical Manuka honey post-thyroidectomy: A randomized control study.

ObjectiveLeptospermum Honey (Manuka honey) has proven to be effective in improving acute and chronic wound healing presumably due to its antibacterial and anti-inflammatory properties. The aim is to determine if Manuka honey decreases scar formation and results in a cosmetically appealing scar.MethodsA prospective single-blinded randomized control trial was performed. All patients received an 8 cm incision. Patients randomized to honey treatment were instructed to apply Manuka honey paste topically to the incision site once per day post surgery for 4 weeks. The patients' scar was then analyzed objectively by a blinded observer and subjectively at 4 and 8 weeks postoperatively. The primary outcome measure used was the Patient and Observer Scar Assessment Scale (POSAS).ResultsA total of 21 patients completed the entire scar analysis (honey treatment = 9, standard treatment = 12). There was no statistically significant difference between patient scar assessment scale and observer scar assessment scale at 4 and 8 weeks postoperatively.ConclusionDespite Leptospermum Honey's reported anti-inflammatory and antibacterial properties, this study did not show a difference in scar appearance when applied.

A Pilot Study of the Efficacy of Active Leptospermum Honey for the Treatment of Partial-Thickness Facial Burns.

Research suggests that active Leptospermum honey (ALH) improves outcomes in patients with partial-thickness burns by enhancing healing and reepithelialization rates, as well as by protecting against antibiotic-resistant microorganisms. This study assessed the effectiveness of ALH gel on healing time, bacterial growth, patient satisfaction, and cost of treatment. Single-arm, prospective case series. Seven patients (aged 7-64 years) with partial-thickness facial burns were recruited from a northeastern US burn center. All patients cleansed their wounds daily with soap and water, after which they applied ALH gel. Three physicians independently rated healing using wound photography and daily tests for the presence of exudate. Wound cultures on days 1 and 7 (±2 days) assessed bacterial growth. Patients completed a satisfaction survey at the end of treatment, and cost of treatment was calculated. Healing time ranged from 3 to 14 days (mean, 8.1 days). Wound cultures revealed normal bacterial growth on days 1 and 7 for all patients. Patients rated ALH gel favorably, with the most common complaint of stickiness in 5 patients. One patient experienced transient burning on application that did not interrupt treatment. Average hospital-based cost of treatment was $26.15 per patient. Healing time was congruent with or better than what would have been expected with standard treatment. Furthermore, despite no antibiotic treatment, wound culture results yielded no abnormal bacterial growth. Finally, patients overall reported satisfaction with treatment. The findings of this study suggest that ALH is a clinically and economically valuable treatment for partial-thickness facial burns.

Safety and efficacy of active Leptospermum honey in neonatal and paediatric wound debridement.

Safety is a critically important factor in the selection of products used in neonatal and paediatric wound care. Given the lack of standardisation of neonatal and paediatric wound care protocols, the goal of this study was to present data on the safety and efficacy of active Leptospermum honey (ALH) in this patient population. A multicentre, retrospective chart review was conducted at eight inpatient facilities and one outpatient clinic between October 2011 and March 2014. The number of applications of ALH, adverse events, and the success of debridement and wound healing were recorded. Data were collected on 115 neonatal and paediatric patients, with 121 wounds requiring debridement, treated with ALH. Patients were treated for an average of 18.7 days. ALH was well tolerated, with two (1.7%) patients reporting adverse events involving a transient stinging sensation on application, which did not prohibit additional applications of ALH. Successful debridement was achieved in 86.0% (104 wounds), and 77.7% (94 wounds) were successfully closed using nonsurgical intervention. Outcomes in neonates were similar to the overall paediatric population, with 86.1% (31/36) wounds successfully debrided with no adverse events. In a subset of six patients with available pre- and post-treatment data, no clinically meaningful changes in white blood cell counts or glucose levels were associated with the initiation of treatment with ALH. The results of this study support ALH as a safe and effective treatment option in this group of patients. This study was supported by a grant from Derma Sciences (Princeton, NJ USA). Dr Amaya is a paid speaker for Derma Sciences.

Neonatal Case Studies Using Active Leptospermum Honey

Treatment of the neonatal patient with clinically complex wounds creates a challenge due to the safety and efficacy issues associated with the use of many advanced wound care products. The purpose of this case series was to present outcomes of 3 neonates with wounds of differing etiologies managed by Active Leptospermum Honey (ALH). Clinical case series. Clinical experiences with 3 neonates, 1 male and 2 females, are described. These premature infants received care at Rush University Medical Center, Houston, Texas, or Driscoll Children's Hospital, Corpus Christi, Texas. Each neonate presented with dissimilar wounds and differing treatment goals. For a premature infant with left foot ischemia, ALH dressings allowed for removal of nonviable tissue and facilitated the granulation of the open wounds. This removal of nonviable tissue coupled with the facilitation of granulation tissue enabled the premature infant's toe tips to be salvaged without requiring aggressive surgical intervention. For the 2 preterm infants with extravasation of intravenous solutions, ALH dressings allowed healing and increased tissue granulation without any noted toxicity to the wound bed. Further, the method of action of ALH includes an osmotic pull effect that reduced periwound erythema and edema. Although the use of ALH has been well documented in adult care, these case studies demonstrate its potential use in different wound etiologies in 3 neonatal patients.

Clinical experience with Leptospermum honey use for treatment of hard to heal neonatal wounds: case series

Preterm, critically ill neonates represent a challenge in wound healing. Many factors predispose infants to skin injuries, including decreased epidermal-dermal cohesion, deficient stratum corneum, relatively alkaline pH of skin surface, impaired nutrition and presence of multiple devices on the skin. We present a case series describing the use of medical-grade honey-Leptospermum honey (Medihoney), for successful treatment of slowly healing neonatal wounds, specifically stage 3 pressure ulcer, dehiscent and infected sternal wound, and full-thickness wound from an extravasation injury.

Specific non-peroxide antibacterial effect of manuka honey on the Staphylococcus aureus proteome

Manuka honey, derived from the New Zealand flowering plant Leptospermum scoparium, shows promise as a topical antibacterial agent and effective chronic wound dressing. The aim of this study was to determine the non-peroxide antibacterial effects of this honey on the proteome of the common wound pathogen Staphylococcus aureus. Proteomic analysis was performed on cells treated for a short time with manuka honey compared with the proteome of untreated cells as well as cells treated with a Leptospermum honey sample without antibacterial activity. Treatment with manuka honey resulted in a significant decrease in the bacterial cell growth rate as well as downregulation of ten and upregulation of two proteins. Nine of these proteins were also differentially expressed by cells treated with the inactive Leptospermum honey, but to a lesser degree, and the rate of bacterial growth was not affected. The differentially expressed proteins have roles in ribosomal function, protein synthesis, metabolic processes and transcription. Manuka honey uniquely caused downregulation of two proteins [dihydrolipoamide dehydrogenase (DLD) and elongation factor Tu (EF-Tu)] associated with two of these pathways as well as upregulation of one stress-related protein [cold shock protein C (CspC)]. The proteomic profile following treatment with manuka honey differed from the profiles of other antibacterial agents, indicating a unique mode of action and its potential value as a novel antimicrobial agent.

Randomised controlled feasibility trial on the use of medical grade honey following microvascular free tissue transfer to reduce the incidence of wound infection

The aim of this study was to assess the feasibility of using Leptospermum honey in a randomised trial to reduce the incidence of wound infection after microvascular free tissue reconstruction for cancer of the head and neck. During the one-year study period 70 consecutive patients were admitted to the regional maxillofacial ward for free tissue reconstruction. Of these, 56 (80%) consented to be randomised and 49 (70%) were actually randomised, 25 into the honey dressings group, and 24 into the conventional dressings group (control). Six patients were missed when consent was required, 8 did not consent, and 7 who had given consent were missed at the randomisation stage in theatre. Results of wound swabs were positive in 36% of the honey group and 38% of the control group. Methicillin-resistant Staphylococcus aureus (MRSA) was found in 28% and 25%, respectively. Of these, 38% were deemed to require intervention. Honey dressings were acceptable to both patients and nurses. There was a reduction (p<0.05) in duration of hospital stay in the honey group (median 12 days, IQR 10–21) compared with the control (median 18 days, IQR 13–28). The cost of standard and honey dressings was similar. This feasibility study has shown that a randomised controlled trial (RCT) is possible and that several hundreds of patients would be required to show a clinical benefit for honey. Further research is needed to confirm a shorter duration of hospital admission and if so, whether this is due to more rapid healing.