מאמר שהתפרסם החודש ב- The Journal of Family Practice

Topical honey useful for patients with refractory diabetic foot ulcers

In the June issue of The Journal of Family Practice there is an informative article on the value of honey in treating diabetic ulcers that begins: “A 79-year-old man with type 2 diabetes mellitus developed heel and forefoot ulcers, for which he received currently recommended therapy, including an off-loading orthotic, systemic antibiotics selected by infectious disease consultants, and topical therapies directed by a wound care expert. After 14 months of care costing $390,000—a cost that included 5 hospitalizations and 4 surgeries—the ulcers measured 8 x 5 cm and 3 x 3 cm. Deep tissue cultures grew methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Pseudomonas. During this time the patient lost two toes but refused below-the-knee amputation, despite being informed by two different surgical teams that without it he would likely die. This opinion was based on the patients recurrent episodes of heel osteomyelitis and multiple medical complications, including acute renal failure from culture-specific antibiotics.The patient was eventually discharged to his home at his request, after consulting with his family and the hospitals ethics committee. He lost a third toe before consenting to a trial of topical honey.”

Topical honey useful for patients with refractory diabetic foot ulcers

In the June issue of The Journal of Family Practice there is an informative article on the value of honey in treating diabetic ulcers that begins: “A 79-year-old man with type 2 diabetes mellitus developed heel and forefoot ulcers, for which he received currently recommended therapy, including an off-loading orthotic, systemic antibiotics selected by infectious disease consultants, and topical therapies directed by a wound care expert. After 14 months of care costing $390,000—a cost that included 5 hospitalizations and 4 surgeries—the ulcers measured 8 x 5 cm and 3 x 3 cm. Deep tissue cultures grew methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Pseudomonas. During this time the patient lost two toes but refused below-the-knee amputation, despite being informed by two different surgical teams that without it he would likely die. This opinion was based on the patients recurrent episodes of heel osteomyelitis and multiple medical complications, including acute renal failure from culture-specific antibiotics.The patient was eventually discharged to his home at his request, after consulting with his family and the hospitals ethics committee. He lost a third toe before consenting to a trial of topical honey.”

Course of treatment with honey: Once-daily, thick applications of ordinary honey purchased at a supermarket were smeared on gauze 4x4s and placed on the wounds, which were then wrapped. Oral antibiotics and saline dressings were discontinued, but otherwise treatment was unchanged. Since the patients family purchased and applied the honey, the cost of this therapy was merely that of the dressings. Dressing changes were painless and the serum glucose remained in excellent control. Granulation tissue appeared within 2 weeks; in 6 to 12 months the ulcers resolved.. Two years later, the ulcers have not recurred; the patient ambulates with a walker and reports improved quality-of-life.

Honey as wound treatment in the medical literature: Honey has been used to treat wounds for millennia, but the medical evidence
supporting its use is limited. While there are many case reports of honeys effectiveness, 7 controlled trials demonstrating effectiveness for treating burns and wounds are limited by poor quality and the use of nonstandard controls, while another trial found minimal benefit when “a very thin smear” was used. Concerns about wound infection from Clostridium spores appear unfounded, as no such complication has been described in more than 500 reports in the literature, and honey has repeatedly been shown to suppress bacterial growth. Gamma-irradiated “medical” honey is available, which has also been selected for its potent antibacterial properties, although most of the cases in the medical literature have used raw honey. A burning or stinging sensation has been described with honeys topical use.

As rates of diabetes increase, it is important to identify effective strategies to reduce amputation rates, both to improve quality of life and to decrease cost. Given honeys potential for improved outcomes, cost savings, and decreasing antibiotic use and resistance, we advocate publicly funded randomized controlled trials to determine its efficacy.. Meanwhile, we encourage others to consider topical honey therapy for patients with refractory diabetic foot ulcers.

Topical honey for diabetic foot ulcers, Jennifer J. Eddy, MD, and Mark D. Gideonsen, MD The Journal of Family Practice June 2005 Vol. 54, No. 6.

© Dowden Health Media

Synopsis edited by Professor Wes Fabb, Melbourne. Posted on Global Family Doctor 22 June 2005