We found seven randomised trials [17
], six performed in India by the same researcher [18
], and one [17
] performed in the United Arab Emirates (supplementary material
). Two of the studies involved superficial burns [19
], three partial thickness burns [20
], one moderate to severe burns that included full thickness injury [18
], and one infected postoperative wounds [17
]. All the controls were active comparisons, though these included potato peelings [20
] and amniotic membrane [21
] as well as conventional treatments. The main outcomes were the effects of honey and controls on healing time and infection rate, though antibiotic use and hospital stay were also noted in some studies.
None of the studies was blinded and only one designated a primary outcome [23
]. The quality score for each trial was 1 out of a possible range of 1-5, and validity scores ranged between 5 and 10 out of range of 0 to 16. Of the seven studies, six were deemed positive by the original authors and by authors of this review. One [18
] was negative, where tangential excision was statistically better than honey. Because the quality score was 1 in all trials, sensitivity analysis was not possible. Five studies had a mean OPVS score of 8 or less, and four were positive. Both studies with validity scores above 8 were positive.
The single study in infected postoperative wounds compared honey with antiseptics in addition to systemic antibiotics after culture and sensitivity [17
]. For all outcomes honey was significantly better, with much shorter times for healing, eradication of infection, use of antibiotics and hospital stay (supplementary material). The proportion of wounds healed without dehiscence or resuturing was 22/26 (85%) for honey compared with 12/24 (50%) with antiseptic. The number needed to treat with honey for good wound healing compared with antiseptic was 2.9 (1.7 to 9.7).
The single study of moderate or severe burns [18
] compared honey with tangential excision. For all outcomes tangential excision followed by grafting by six days post burn was significantly better than initial honey treatment followed by grafting where necessary. Half of all the patients had full thickness burns, and half of those treated with honey eventually needed skin grafts.
The other five studies [19
] were conducted in patients with partial thickness or superficial burns involving less than 40% of the body surface. Comparators were polyurethane film [22
], amniotic membrane [21
], potato peel [20
] and silver sulphadiazine [19
]. For some or all outcomes honey was superior to all these treatments. Time for healing was significantly shorter for honey than all these treatments.
Four studies had dichotomous information about the number of patients healed or with wounds initially infected but which became sterile on treatment [19
]. Information from these studies has been combined for all four comparisons and for those comparisons (potato, amniotic membrane) where there was no biological plausibility for efficacy (Table ). The study without dichotomous information [22
] reported a statistically significant reduced mean healing time of 10.8 days with honey compared with 15.3 days with polyurethane film.
Major outcomes for wound healing and infection for superficial and partial thickness burns
Treatment with honey produced significantly more healing at seven days. At seven days 58% (97/167) of patients were healed with honey, and 19% (29/151) with other treatments (Figure ). The number needed to treat for seven days with honey to produce one patient with a healed burn was 2.6 (2.1 to 3.4) compared with any other treatment and 2.7 (2.0 to 4.1) for potato and amniotic membrane. By 21 days 99% (165/167) of patients were healed with honey, and 75% (113/151) with other treatments. The number needed to treat for 21 days with honey to produce one patient with a healed burn was 4.2 (3.3 to 6.0) compared with any other treatment.
Percent of patients healed with honey and other treatments after seven days. The size of the symbol is proportional to the size of the study.
At seven days 85% (114/134) of patients with initially infected wounds had them rendered sterile with honey compared with 30% (37/124) for other treatments (Figure ). The number needed to treat for seven days with honey to produce one patient with a sterile wound was 1.8 (1.5 to 2.2) compared with any other treatment and 1.7 (1.4 to 2.3) for potato and amniotic membrane. Only one study gave the sterile wound rate at 21 days, 96% for honey and 76% for silver sulphadiazine based on limited numbers of patients.
Percent of patients with infected wounds rendered sterile with honey and other treatments after seven days. The size of the symbol is proportional to the size of the study.
The absence of any adverse effects with honey was positively reported in three studies [17