The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of/unclear blinding).
A Cochrane review [Abstract] 1 included 26 studies with a total of 3 011 subjects. Three studies evaluated the effects of honey in minor acute wounds, 11 studies evaluated honey in burns, 10 studies recruited people with different chronic wounds including 2 in people with venous leg ulcers, 2 studies in people with diabetic foot ulcers and single studies in infected post-operative wounds, pressure injuries, cutaneous Leishmaniasis and Fournier's gangrene. Two studies recruited a mixed population of people with acute and chronic wounds.
Honey dressings healed partial thickness burns more quickly than conventional dressings (WMD -4.68 days, 95% CI -5.09 to -4.28; 2 studies, n=992). In one of the two studies the control dressing was a polyurethane film dressing whilst in the other the control group received a range of interventions (polyurethane film, paraffin gauze, sterile linen, framyecetin-impregnated tulle, left exposed). Burns treated with honey healed more quickly than those treated with silver sulfadiazine (SSD) (WMD -5.12 days, 95% CI -9.51 to -0.73, statistical heterogeneity I2 = 93%; 4 studies, n=332). There was 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; 6 studies, n=462) but a reduction in the overall risk of adverse events with honey relative to SSD (RR 0.29, 95% CI 0.2 to 0.42; 6 studies, n=412). Early excision and grafting healed 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; 1 study, n=50).
Honey healed a mixed population of acute and chronic wounds more quickly than SSD or sugar dressings (2 studies, n=140). In addition to systemic antibiotics, honey healed infected post-operative wounds more quickly than antiseptic washes followed by gauze (RR of healing 1.69, 95% CI 1.10 to 2.61; 1 study, n=50) and was associated with fewer adverse events. Honey healed more pressure ulcers compared with saline soaks (proportion of healed at 10 days: RR 1.41, 95% CI 1.05 to 1.90; 1 study, n= 40), and healed Fournier's gangrene more quickly than Eusol soaks (WMD -8.00 days, 95% CI -6.08 to -9.92 days; 1 study, n=30).The effects of honey relative to comparators were unclear for venous leg ulcers (2 studies, n= 476), minor acute wounds (3 studies, n=213), diabetic foot ulcers (2 studies, n=93), Leishmaniasis (1 study, n=100), and mixed chronic wounds (2 studies, n=150).
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