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The University of Waikato,
New Zealand, Honey Research Unit
as an Antiseptic Dressing
Established Usage of Honey as a Dressing
Honey has a well established usage as a wound dressing in ancient and
10. In recent times this has been re-discovered, and honey is in
fairly widespread use as a topical antibacterial agent for the treatment of
wounds, burns and skin ulcers, there being many reports of its effectiveness
11-23. The observations recorded are that inflammation, swelling
and pain are quickly reduced, unpleasant odours cease, sloughing of necrotic
tissue occurs without the need for debridement, dressings can be removed
painlessly and without causing damage to re-growing tissue, and healing
occurs rapidly with minimal scarring, grafting being unnecessary. In many of
the cases honey was used on infected lesions not responding to standard
antibiotic and antiseptic therapy. It was found in almost all of the cases
to be very effective in rapidly clearing up infection and promoting healing.
Importance of Antibacterial Activity
Much of the effectiveness of honey as a dressing appears to be due to its
antimicrobial properties. The healing process will not occur unless
infection is cleared from a lesion: swabbing of wounds dressed with honey
has shown that the infecting bacteria are rapidly cleared
24. In this respect honey is superior to the expensive modern
hydrocolloid wound dressings as a moist dressing. Although tissue re-growth
in the healing process is enhanced by a moist environment, and deformity is
prevented if the re-growth is not forced down by a dry scab forming on the
surface, moist conditions favour the growth of infecting bacteria.
Antibiotics are ineffective in this situation, and antiseptics cause tissue
damage, so slow the healing process
25. Honey is reported to cause no tissue damage, and appears to
actually promote the healing process. There are also numerous reports of
sugar being used as a wound dressing, this also being found to be effective
26-31. Antibacterial activity is attributed by several authors to
the high osmolarity of the sugar or honey
27, it not being generally recognised that some honeys can have
additional antibacterial activity considerably greater than that due to the
osmolarity. This additional activity would be of particular significance in
situations where the dressing becomes diluted by body fluids, and in regions
of a lesion that are not in direct contact with the dressing.
Staphylococcus aureus is exceptionally osmotolerant: for complete
inhibition of its growth the aw has to be lowered below 0.86,
which would be a typical honey at 29% (v/v). In the reports of sucrose syrup
or paste being used as a wound dressing it is noted that infection with
Staphylococcus aureus is hard to clear. Measurements that have been
27 of the dilution occurring from the uptake of water from
surrounding tissues when an abdominal wound was packed with sugar reveal
that a saturated sucrose syrup containing undissolved granules becomes
diluted in 7.5 hours to a concentration that is 30% of that of a saturated
solution. Although the aw of this solution is low enough to
prevent the growth of most human pathogens, it is not low enough to
seriously restrict the growth of Staphylococcus aureus, a species
which has developed resistance to many antibiotics and has become the
predominant agent of wound sepsis in hospitals
32. But Staphylococcus aureus is one of the species most
sensitive to the antibacterial activity of honey. There have been many
reports of complete inhibition of Staphylococcus aureus by honeys
diluted to much lower concentrations
4, showing the importance of the other antibacterial factors in
To know for certain the clinical significance of the additional
antibacterial activity in honey, a clinical trial will need to be conducted
to compare dressings of sugar and selected honeys. The little comparative
work reported to date indicates that more rapid healing is achieved with
honey than with sugar
15. Since infection is one of the most common impediments to wound
33, then such results would be expected if the sugar dressing were
not able to fully suppress the growth of bacteria as the sugar became
diluted. The additional antibacterial activity of honey could be the reason
for the remarkable rates of healing reported when honey has been used as a
Effectiveness against Wound-infecting Species of Bacteria
The seven species of bacteria most commonly involved in wound infection
have been tested for their sensitivity to the antibacterial activity of
34. The two major forms of antibacterial activity were examined
separately: a honey with an average level of activity due to hydrogen
peroxide and no detectable non-peroxide activity was used; also a manuka
honey with an average level of non-peroxide activity, with catalase added to
remove any hydrogen peroxide. The results of this study are summarised in
Overall there was little difference between the two types of
antibacterial activity in their effectiveness, although some species were
more sensitive to the action of one type of honey than they were to the
other. The results thus showed that these honeys, with an average level of
activity, could be diluted nearly ten-fold yet still completely inhibit the
growth of all the major wound-infecting species of bacteria. It is notable
that the manuka honey, with an average level of activity, could be diluted
with 54 times its volume of fluid yet still completely inhibit the growth of
Staphylococcus aureus, the major wound-infecting species, and a species
notorious for its development of resistance to antibiotics.
Table 1. The minimum concentration of honey (%, v/v) in the growth medium
needed to completely inhibit the growth of various species of
There are frequent reports of hospital wards being closed because of the
presence of strains of methicillin-resistant Staphylococcus aureus
(MRSA). Because these strains are resistant to all of the antibiotics in
common use it is necessary to protect patients with impaired immunity from
exposure to them in case they contract infections which will not respond to
treatment. The collection of strains of MRSA at Waikato Hospital have been
tested for sensitivity to the two honeys described above
35. All of the strains were found to be completely inhibited by
both honeys at 10% (v/v) in the growth medium, and many of the strains by
the honeys at 5% (v/v).
- Dustmann J H. (1979) Antibacterial Effect of
Honey. Apiacta 14, 7-11.
- Majno G: The Healing Hand. Man and Wound in the
Ancient World. Harvard University Press Cambridge, Massachusetts.
- Ransome H M: The Sacred Bee in Ancient Times
and Folklore. George Allen and Unwin London. 1937.
- Molan P C. (1992) The Antibacterial Activity of
Honey. 1. The Nature of the Antibacterial Activity. Bee World
- Molan P C. (1992) The Antibacterial Activity of
Honey. 2. Variation in the Potency of the Antibacterial Activity. Bee
World 73, 59-76.
- Aristotle (350 B.C.). Translated by Thompson DÕA
W. Historia Animalium in: The Works of Aristotle (Smith J A, Ross
W D editors) Oxford University Press Oxford 1910 Volume IV.
- Gunther R T: The Greek Herbal of Dioscorides
(Translated by Goodyear J, 1655). Hafner N. Y. 1934, reprinted 1959.
- Allen K L, Molan P C, Reid G M. (1991) A Survey of
the Antibacterial Activity of Some New Zealand Honeys. J. Pharm.
Pharmacol. 43, 817-822.
- Allen K L, Molan P C, Reid G M. (1991) The
Variability of the Aantibacterial Activity of Honey. Apiacta
- Zumla A, Lulat A. (1989) Honey - a Remedy
Rediscovered. J. Royal Soc. Med. 82, 384-3
- Bulman M W. (1955) Honey as a Surgical Dressing.
Middlesex Hosp. J. 55, 188-189.
- Hutton D J. (1966) Treatment of Pressure Sores.
Nurs. Times 62, 1533-1534.
- Cavanagh D, Beazley J, Ostapowicz F. (1970)
Radical Operation for Carcinoma of the Vulva. A New Approach to Wound
Healing. J. Obstet. Gynaecol. Br. Cmwlth. 77, 1037-1
- Blomfield R. (1973) Honey for Decubitus Ulcers.
J. Am. Med. Assoc. 224, 905.
- Burlando F. (1978) Sull'azione Terapeutica del
Miele nelle Ustioni. Minerva Dermat. 113, 699-706.
- Armon P J. (1980) The Use of Honey in the
Treatment of Infected Wounds. Trop. Doct. 10, 91.
- Bose B. (1982) Honey or Sugar in Treatment of
Infected Wounds? Lancet i, 963.
- Dumronglert E. (1983) A Follow-up Study of Chronic
Wound Healing Dressing with Pure Natural Honey. J. Natl Res. Counc.
Thail. 15, 39-66.
- Kandil A, Elbanby M, Abd-Elwahed K, Abou Sehly G,
Ezzat N. (1987) Healing Effect of True Floral and False Nonfloral Honey
on Medical Wounds. J. Drug Res. (Cairo) 17, 71-
- Effem S E E. (1988) Clinical Observations on the
Wound Healing Properties of Honey. Br. J. Surg. 75,
- Farouk A, Hassan T, Kashif H, Khalid S A, Mutawali
I, Wadi M. (1988) Studies on Sudanese Bee Honey: Laboratory and Clinical
Evaluation. Int. J. Crude Drug Res. 26, 161-168.
- Green A E.(1988) Wound Healing Properties of
Honey. Br. J. Surg. 75, 1278.
McInerney R J F. (1990) Honey - a Remedy
Rediscovered. J. Royal Soc. Med. 83, 127.
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