Data from eligible trials were extracted and summarised by one review author, using a data extraction sheet, and independently verified by a second review author. All data have been subsequently checked by two more authors.
MAIN RESULTS: We identified 26 eligible trials (total of 3011 participants). Three trials evaluated the effects of honey in minor acute
wounds, 11 trials evaluated honey in
burns, 10 trials recruited people with different chronic
wounds including two in people with venous
leg ulcers, two trials in people with
diabetic foot ulcers and single trials in infected post-operative
wounds,
pressure injuries,
cutaneous Leishmaniasis and
Fournier's gangrene. Two trials recruited a mixed population of people with acute and chronic
wounds. The quality of the evidence varied between different comparisons and outcomes. We mainly downgraded the quality of evidence for risk of bias, imprecision and, in a few cases, inconsistency.There is high quality evidence (2 trials, n=992) that honey dressings heal partial thickness
burns more quickly than conventional dressings (WMD -4.68 days, 95%CI -5.09 to -4.28) but it is unclear if there is a difference in rates of adverse events (very low quality evidence) or
infection (low quality evidence).There is very low quality evidence (4 trials, n=332) that
burns treated with honey heal more quickly than those treated with
silver sulfadiazine (
SSD) (WMD -5.12 days, 95%CI -9.51 to -0.73) and high quality evidence from 6 trials (n=462) that there is no difference in overall risk of healing within 6 weeks for honey compared with
SSD (RR 1.00, 95% CI 0.98 to 1.02) but a reduction in the overall risk of adverse events with honey relative to
SSD. There is low quality evidence (1 trial, n=50) that early excision and grafting heals partial and full thickness
burns more quickly than honey followed by grafting as necessary (WMD 13.6 days, 95%CI 9.82 to 17.38).There is low quality evidence (2 trials, different comparators, n=140) that honey heals a mixed population of acute and chronic
wounds more quickly than
SSD or
sugar dressings.Honey healed infected post-operative
wounds more quickly than
antiseptic washes followed by gauze and was associated with fewer adverse events (1 trial, n=50, moderate quality evidence, RR of healing 1.69, 95%CI 1.10 to 2.61); healed
pressure ulcers more quickly than saline soaks (1 trial, n= 40, very low quality evidence, RR 1.41, 95%CI 1.05 to 1.90), and healed
Fournier's gangrene more quickly than
Eusol soaks (1 trial,
n=30, very low quality evidence, WMD -8.00 days, 95%CI -6.08 to -9.92 days).The effects of honey relative to comparators are unclear for: venous
leg ulcers (2 trials, n= 476, low quality evidence); minor acute
wounds (3 trials, n=213, very low quality evidence);
diabetic foot ulcers (2 trials, n=93, low quality evidence);
Leishmaniasis (1 trial, n=100, low quality evidence); mixed chronic
wounds (2 trials, n=150, low quality evidence).
AUTHORS' CONCLUSIONS: It is difficult to draw overall conclusions regarding the effects of honey as a topical treatment for
wounds due to the heterogeneous nature of the patient populations and comparators studied and the mostly low quality of the evidence. The quality of the evidence was mainly downgraded for risk of bias and imprecision. Honey appears to heal partial thickness
burns more quickly than conventional treatment (which included
polyurethane film,
paraffin gauze,
soframycin-impregnated gauze, sterile linen and leaving the
burns exposed) and infected post-operative
wounds more quickly than
antiseptics and gauze. Beyond these comparisons any evidence for differences in the effects of honey and comparators is of low or very low quality and does not form a robust basis for decision making.