It is well documented that honey can act as an antimicrobial and antioxidative agent as well as an immunomodulator with both pro- and anti-inflammatory effects (Figure 1). Historically, honey has been used in the treatment of a broad spectrum of wounds. Honey as a Traditional Antimicrobial Agent Moreover, some of the natural therapies such as maggot debridement therapy and phage therapy have recently been reexamined for their potential usefulness in the treatment of wounds that are difficult to heal. The major arguments for implementing natural products such as honey, aloe vera or curcumin are the low cost and absence of antimicrobial resistance risk in comparison with conventional wound-care products. With increasing frequency, modern medicine directs attention to natural products with antimicrobial activity and their use in clinical practice. Silver resistance has already been documented in bacterial isolates including Escherichia coli, Enterobacter cloacae, Klebsiella pneumonie, Salmonella typhimurium and Acinetobacter baumani. Increased use of ionic silver in wound care has created some concern regarding the development of bacterial resistance.
Various approaches have been developed for the treatment of diabetic ulcers including topical wound-care therapies.Ĭurrent therapeutic products which are being used widely in wound care, such as silver sulfadiazine, hydrogel, hydrocolloid and alginate dressings impregnated with silver, are generally accepted as being useful for control of bacterial infections. Treatment of foot ulcers is protracted and intensive and associated with high costs. Among persons diagnosed with diabetes mellitus, the prevalence of foot ulcers is 4%–10%. The occurrence of diabetic foot ulcers is a serious complication which negatively affects patients’ quality of life. The prevalence of diabetes is rapidly increasing worldwide. We advocate randomized controlled trials to determine efficacy and safety of manuka honey in this population. Further detailed research is needed to fully elucidate the participation of honey/derived MG in healing diabetic ulcers. This commentary describes the concern that MG in manuka honey may delay wound healing in diabetic patients. MG and AGEs play a role in the pathogenesis of impaired diabetic wound healing and can modify the structure and function of target molecules. MG is a potent protein-glycating agent and an important precursor of advanced glycation end products (AGEs). The concentration of MG in manuka honeys is up to 100-fold higher than in conventional honeys. Recently, it has been documented that the pronounced antibacterial activity of manuka honey is due, at least in part, to reactive methylglyoxal (MG). Manuka honey has been claimed to have therapeutic advantages over other honeys.
However, as yet, there are inadequate supportive robust randomized trials and experimental data to fully accept honey as an effective medical product in wound care. Honey has been considered as a remedy in wound healing since ancient times.
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