Since antediluvian times, guesss have been made about the healing belongingss of honey. The ancient Greeks, Chinese and Romans used honey to mend lesions and remedy diseases of the GI piece of land. Today, the usage of honey in lesion direction has greatly resurged chiefly due to increasing clinical jobs of antibiotic-resistant bacteriums and the combined troubles for the practician in pull offing chronic lesion types, such as Burnss, leg ulcers or surgical lesions, which may go septic. The application of honey to badly septic lesions clears infection and besides improves tissue mending. The development and licensing of modern honey lesion dressings has relieved many patients from the escalating costs associated with handling such lesions. honey besides possess anti-inflammatory activity and stimulates immune response within a lesion. It is besides known that honeys derived from peculiar flowered beginnings in Australia and New Zealand ( Leptospermum spp ) have enhanced antibacterial activity, and these honeys have been approved for marketing as curative honeys. Namely, active Manuka honey. This reappraisal outlines what is known about the medical belongingss of honey and indicates the possible for honey to be incorporated into the direction of a big figure of wound types. This article besides focuses on the possible importance of honey in modern twenty-four hours medicate due to its antibacterial belongingss.
For centuries, honey has been used as an effectual redress for lesions and Burnss, yet, there was no acknowledgment of its antimicrobic belongingss. Recently, there have been renewed involvement in the medicative belongingss of honey. the effectivity of honey in many of its medical utilizations is likely due to its antibacterial activity. It is good established that honey restrains a wide-range of bacterial species. There are many studies of honey holding bactericidal every bit good as fungicidal activity. That is, honey is active against a broad scope of bacterial and fungous species, many of which cause infections. These legion studies of the antimicrobic activity of honey will been comprehensively outlined in this reappraisal.
There are many characteristics in the composing of honey that together unite to give it its antimicrobic belongingss. From the legion surveies conducted on the antimicrobic belongingss of honey, a few have been highlighted below:
How does honey work to handle infections?
There are many characteristics in the composing of honey that together unite to give it its antimicrobic belongingss.
Honey is a concentrated or supersaturated solution of sugars. For case, about eighty four per centum comprises of glucose and fruit sugar while, the H2O content is normally less than twenty one per centum by weight. The deficiency of aa‚¬E?freeaa‚¬a„? H2O inhibits the growing of micro-organisms. Therefore, many species of bacteriums have their growing wholly inhibited.
When honey is diluted by lesion exudations, H peroxide is produced through a glucose oxidase enzyme reaction. Upon dilution of honey, the activity additions by a factor of 2,500 – 50,000. This is gradual release of H peroxide provides antibacterial activity and does non damage the tissue.
2.1.4. Phytochemical Factors
Some honeys still have antimicrobic activity even when H peroxide activity has been removed. The honey from Manuka trees ( Leptospermum scoparium ) has been found to hold high degrees of this antibacterial phytochemical. It has besides been discovered that by subjecting honey to alot of heat inactivates the glucoe oxidase which causes the loss of activity against some species while retaining it against the remainder.
Variation in Antibacterial Activity
For decennaries it has been known that different types of honey exhibit differences in the grade of antibacterial activity. In recent old ages, honey from different beginnings has been studied and a few have been identified as holding peculiarly high antibacterial activity. Namely, the Manuka honey gathered from the manuka tree Leptospermum scoparium, native to New Zealand, has exceptionally high antibacterial activity, with about half of this type of honey holding high degrees of non-peroxide activity ( that is: high degrees of antibacterial phytochemical activity nowadays ) . It is imperative for honey to hold this auxiliary non-peroxide antibacterial constituent as factors such as sourness, catalase and protein-digesting enzymes in wound fluids all work towards take downing the H peroxide antibacterial effectivity. However, it is recommended that honey collected in specific parts and seasons ( and hence presumptively from different flowered beginnings ) be used for the intervention of peculiar complaints. A few decennaries ago, it was recognised that there are differences in the antibacterial activity of different types of honey and a method was devised to find the “ inhibine figure ” of honeys. The inhibine figure is a step of the antibacterial activity. Such that, the grade of dilution to which a honey will retain its antibacterial activity. The major fluctuations seen in overall antibacterial activity are due to fluctuation in the degree of H peroxide that arises in honey, and in some instances to the degree of non-peroxide factors.
Honey for the Treatment of Gastroenteritis
Honey has been found to be a utile constituent in the intervention of bacterial stomach flu in babies. It is used in topographic point of glucose in an unwritten re-hydration fluid. The antibacterial activity of honey cleared the infection in bacterial diarrhea. Furthermore, honey was tested for its antibacterial authority against all the bacterial species that normally do stomach flu, comparing Manuka honey and a honey with the usual H peroxide activity and besides an unreal honey to measure how much of the antibacterial activity was due merely to the sourness and the osmotic consequence of the sugar in honey. it was discovered that honey with an mean degree of hydrogen peroxide activity is bacteriostatic at 4-8 % ( v/v ) and bactericidal at 5-10 % ( v/v ) . The non-peroxide activity of an mean manuka honey is bacteriostatic at 5-11 % ( v/v ) and bactericidal at 8-15 % ( v/v ) . Bacteriostatic activity was non seen with unreal honey unless it was at 20-30 % ( v/v ) , clearly demoing the importance of factors other than sugar and sourness.
Potential Uses of Honey as an Antimicrobial Agent
Restrictions to Usage
The antimicrobic activity would be undistinguished when an unwritten dosage of honey becomes diluted after soaking up from the intestine into the many liters of fluid in the circulation and tissues of the organic structure. In add-on, the potency for honey as an antimicrobic agent in medical specialty is in topical application instead than as a systemic agent. However, there are some state of affairss, for case, GI infections or mastitis where the honey could stay localized to be efficaciously antibacterial.
3.2. Honey as an Antiseptic Dressing
3.2.1. Established Use of Honey as a Dressing
Honey has a good established use as a lesion dressing in antediluvian and traditional medical specialty 10. In recent times this has been re-discovered, and honey is in reasonably widespread usage as a topical antibacterial agent for the intervention of lesions, Burnss and tegument ulcers, there being many studies of its effectiveness 11-23. The observations recorded are that redness, swelling and hurting are rapidly reduced, unpleasant smell cease, sheding of necrotic tissue occurs without the demand for debridement, dressings can be removed painlessly and without doing harm to re-growing tissue, and mending occurs quickly with minimum scarring, grafting being unneeded. In many of the instances honey was used on septic lesions non reacting to standard antibiotic and antiseptic therapy. It was found in about all of the instances to be really effectual in quickly uncluttering up infection and advancing healing.
Importance of Antibacterial Activity
Much of the effectivity of honey as a dressing appears to be due to its antimicrobic belongingss. The mending procedure will non happen unless infection is cleared from a lesion: mopping of lesions dressed with honey has shown that the infecting bacteriums are quickly cleared 13, 16, 18, 20, 24. In this regard honey is superior to the expensive modern hydrocolloid lesion dressings as a moist dressing. Although tissue re-growth in the healing procedure is enhanced by a moist environment, and malformation is prevented if the re-growth is non forced down by a dry strikebreaker organizing on the surface, damp conditions favour the growing of infecting bacteriums. Antibiotics are uneffective in this state of affairs, and antiseptics cause tissue harm, so decelerate the healing procedure 25. Honey is reported to do no tissue harm, and appears to really advance the healing procedure. There are besides legion studies of sugar being used as a lesion dressing, this besides being found to be effectual 26-31. Antibacterial activity is attributed by several writers to the high osmolarity of the sugar or honey 11, 17, 22, 27, it non being by and large recognised that some honeys can hold extra antibacterial activity well greater than that due to the osmolarity. This extra activity would be of peculiar significance in state of affairss where the dressing becomes diluted by organic structure fluids, and in parts of a lesion that are non in direct contact with the dressing. Staphylococcus aureus is exceptionally osmotolerant: for complete suppression of its growing the aw has to be lowered below 0.86, which would be a typical honey at 29 % ( v/v ) . In the studies of sucrose sirup or paste being used as a lesion dressing it is noted that infection with Staphylococcus aureus is difficult to unclutter. Measurements that have been reported 27 of the dilution happening from the consumption of H2O from environing tissues when an abdominal lesion was packed with sugar reveal that a saturated saccharose sirup incorporating undissolved granules becomes diluted in 7.5 hours to a concentration that is 30 % of that of a concentrated solution. Although the aw of this solution is low plenty to forestall the growing of most human pathogens, it is non low plenty to earnestly curtail the growing of Staphylococcus aureus, a species which has developed opposition to many antibiotics and has become the prevailing agent of wound sepsis in infirmaries 32. But Staphylococcus aureus is one of the species most sensitive to the antibacterial activity of honey. There have been many studies of complete suppression of Staphylococcus aureus by honeys diluted to much lower concentrations 4, demoing the importance of the other antibacterial factors in selected honeys.
To cognize for certain the clinical significance of the extra antibacterial activity in honey, a clinical test will necessitate to be conducted to compare dressings of sugar and selected honeys. The small comparative work reported to day of the month indicates that more rapid healing is achieved with honey than with sugar 12, 15. Since infection is one of the most common hindrances to injure mending 33, so such consequences would be expected if the sugar dressing were non able to to the full stamp down the growing of bacteriums as the sugar became diluted. The extra antibacterial activity of honey could be the ground for the singular rates of healing reported when honey has been used as a dressing 11, 13, 14.
Honey for the Treatment of Tineas
Honey has been reported to hold fungicidal activity, but non many species of Fungis have been tested. An of import group of Fungi which on a regular basis infect worlds are the dermatophytes ( Deuteromycotina ) . Cutaneous or superficial mycoses, caused through host infection by these Fungis, are one of the most common diseases of worlds. Merely a little figure of species of these, from the genera Epidermophyton, Microsporum and Trichophyton, on a regular basis infect worlds 45. Superficial fungous infections are amongst the most hard diseases to successfully handle, antibiotics which successfully combat bacterial diseases being mostly uneffective against Fungi. A common sensitivity to some fungous infections is hapless host unsusceptibility, therefore bacterial infections may besides be present rather frequently. So a intervention which has both fungicidal and antibacterial activities would be most good. Therefore the effectivity of honey against the dermatophyte species which most often cause superficial mycoses ( ringworms such as tinea and jocks foot ) was investigated 46.
For this probe two kinds of natural honey were used: a assorted grazing land honey with an mean degree of antibacterial activity due to hydrogen peroxide production, and a manuka honey with an mean degree of non-peroxide antibacterial activity. An unreal honey was besides used, to measure how much of the antibacterial activity was due merely to the sourness and the osmotic consequence. The honeys were tested against clinical isolates of seven species of dermatophytes. An agar good diffusion check was used, the contents of the Wellss being replaced with newly prepared honey solutions at 24 hr intervals over the 3 – 4 yearss of incubation. The honeys were diluted with either sterile distilled H2O or a unfertile solution of 0.2 % catalase, a 5 % ( v/v ) measure dilution series being used for proving.
The consequences are summarised in Table 5. No repressive activity was detected with any of the seven species with the grazing land honey at any concentration up to the highest tried, 50 % ( v/v ) , when catalase was present, nor with the unreal honey even at 100 % . This showed that it was the the H peroxide in the grazing land honey, and the non-peroxide activity in the manuka honey, that were suppressing the growing of the Fungi. Although the concentrations of honey needed to suppress some of the dermatophytes are higher than needed to suppress bacteriums, less dilution of the honey is likely with a ringworm than with septic lesions, Burnss and ulcers where there would be serum exudate. It could be that manuka honey may be more effectual
Treatment of Burn Wounds and Skin Ulcers with Honey
Subrahmanyam ( 1991 ) conducted a survey comparing a conventional method of burn intervention ( silver sulfadiazine ) with topical applications of honey. Burn patients of a assortment of ages were divided into two intervention groups. The Burnss of patients in Group 1 were cleaned with saline solution and pure, undiluted, unrefined honey was applied daily. Burns of Group 2 ( control ) were cleaned and covered with gauze that was soaked in 5 % Ag sulfadiazine which was changed daily. Consequences showed that within 7 yearss 91 % of the septic lesions treated with honey were free of infection, compared to less than 7 % of the Ag sulfadiazine treated Burnss. Within 15 yearss, 87 % of the honey treated lesions were healed whereas merely 10 % of the control group lesions were healed. Patients treated with honey experienced less annoyance, more alleviation of hurting, and no allergic reactions or side effects.
Subrahmanyam ( 1991 ) suggests that honey is effectual for intervention of burn lesions because: 1 ) It prevents infection because of its antibacterial or bacteriostatic belongingss ( i.e. , inhibits the growing of both Gram- negative and Gram-positive bacteriums ) . 2 ) It provides a syrupy barrier to fluid loss and wound invasion by bacteriums therefore forestalling infection. 3 ) It contains enzymes which may help the healing procedure by advancing tissue formation. 4 ) It absorbs edema fluid ( Pus ) thereby cleaning the lesion. 5 ) It reduces hurting and annoyance and eliminates violative odor.
Efem ( 1988 ) showed that assorted types of lesions and tegument ulcers which had non responded to conventional methods of intervention such as antibiotics and medicated dressings responded favourably to a topical honey intervention. Wounds and ulcer types treated with honey included: Fournier ‘s sphacelus, burn wounds topical ulcers, bed sores, and diabetic ulcers. After the lesions were cleaned with saline, honey and clean patchs were applied daily. Infected lesions that had non responded to conventional interventions were free of infection within 7 yearss of the first honey application. Following intervention with honey, dead tissue was rapidly replaced with healthy granulation tissue. In some instances, diabetic ulcers were successfully treated with honey and skin transplants, therefore forestalling amputation. Apparently, the antibacterial belongingss of honey allow it to work on lesions and skin ulcers in the same mode it works on Burnss.
The antibacterial activity of honey is partly due to its osmotic effects ( Molan, 1992a ) . Honey is a concentrated or ace saturated solution of sugars and is said to hold osmotic belongingss ( i.e. , water-with drawing ) . Water molecules strongly react with the sugars in honey go forthing small H2O available for microorganism. The bacterium that cause infection are unable to last in honey because they become dehydrated. Molan ( 1992a ) compared the antibacterial activity of natural honey to unreal honey solutions ( i.e. , super saturated solutions of sugars of the same proportion as those in honey ) . Results showed that these unreal honey solutions did non hold the same grade of antibacterial activity as natural honey, bespeaking that while the remotion of H2O from bacterium is of import, other factors are runing to supply the ascertained antibacterial effects.
The presence of H peroxide generated by the enzymatic activity of glucose oxidase in dilute honey besides contributes to its antibacterial activity ( Molan, 1992a ) . As H peroxide decomposes, it generated extremely reactive free groups which react with and kill bacteriums ( Note: Prior to chemical designation of H peroxide, it was frequently referred to as inhibine in the literature ) .
In add-on to its antimicrobic belongingss, honey besides appears to excite lymphocytic and phagocytic activity. These are cardinal organic structure immune responses in the conflict against infection.
What is honey used to handle?
Honey is most normally used as a topical antibacterial agent to handle infections in a broad scope of lesion types. These include:
Diabetic pes ulcers
Infected wound ensuing from hurt or surgery
In most instances, honey is used when conventional antibacterial intervention with antibiotics and antiseptics are uneffective. Numerous surveies have shown that these difficult-to-heal lesions respond good to honey dressings. Inflammation, swelling and hurting quickly subside, unpleasant odours halt, debridement is enhanced as the honey dressings remove dead tissue painlessly and without doing harm to the regrowing cells. Honey promotes rapid mending with minimum scarring.
Honey can besides be used as first assistance intervention for Burnss as it has powerful anti-inflammatory activity.
How to utilize honey on lesions
All hard to mend lesions should be seen by your physician. The following are general tips on how honey may be used for lesion attention.
The sum of honey used depends on the sum of fluid exudating from the lesion. Large sums of exudation require significant sums of honey to be applied.
The frequence of dressing alterations depends on how quickly the honey is being diluted by the exudation. This should go less frequent as the honey starts to work on mending the lesion.
Occlusive dressings aid to forestall honey seeping out from the lesion.
It is best to distribute the honey on a dressing and use this to the lesion than use the honey straight onto the lesion. Dressing tablets pre-impregnated with honey are commercially available and supply an effectual and less mussy option.
Abscesss, pit or deep lesions need more honey to adequately perforate deep into the lesion tissues. The lesion bed should be filled with honey before using the honey dressing tablet.
Honeies from different flowered beginnings in the thermic stableness of their glucose oxidase content, and in the sensitiveness of this H peroxide-producing enzyme to denaturation by light because of a photosensitizing constituent that comes from some flowered beginnings. Thus it is of import that when honey is to be used as an antimicrobic agent it is selected from honeys that have been assayed in the research lab for antimicrobic activity. It is besides of import that honey for usage as an antimicrobic agent be stored at low temperature and non exposed to visible radiation, so that none of the glucose oxidase activity is lost. Although all honey will halt the growing of bacteriums because of its high sugar content, when the sugars are diluted by organic structure fluids this antibacterial action is lost. The extra antibacterial constituents so become of import.