What are the uses of manuka honey?

Uses of Manuka Honey in Clinical Practice

Manuka honey is not recommended for routine use in wound healing, particularly for diabetic foot ulcers, due to insufficient evidence of efficacy according to current clinical guidelines. 1

Evidence on Manuka Honey for Wound Healing

The International Working Group on the Diabetic Foot (IWGDF) provides strong recommendations against using honey or bee-related products for wound healing in diabetes-related foot ulcers, citing low certainty evidence 1. Despite widespread clinical use of honey dressings, there remains insufficient data to support their routine application for enhancing wound healing 2.

Key limitations in the evidence include:

• Studies on honey products are generally small, unblinded, and at high risk of bias 2
• A Cochrane review concluded that the effects of honey relative to comparators on healing was unclear 2
• The only blinded study of royal jelly (another bee product) found no difference in healing compared to placebo 1

Proposed Mechanisms of Action

Despite the lack of strong clinical evidence, laboratory research suggests several potential mechanisms by which Manuka honey might affect wounds:

• Antibacterial properties through multiple mechanisms:

  • Methylglyoxal (MGO) content providing non-peroxide bacteriostatic properties 3
  • High osmolarity creating an environment unfavorable for bacterial growth 4
  • Acidity that may increase oxygen release from hemoglobin 4

• Potential bioactivities that might:

  • Stimulate immune response
  • Suppress inflammation
  • Promote autolytic debridement 4

Antimicrobial Properties

Manuka honey has demonstrated in vitro activity against antibiotic-resistant bacteria, including those commonly found in wound infections 5. Studies show that concentrations of 10-30% honey inhibited the growth of highly antibiotic-resistant organisms 5. However, this laboratory efficacy has not translated to clear clinical benefits in well-designed trials.

Novel Delivery Methods Under Investigation

Recent research has explored innovative delivery methods for Manuka honey, including:

• Incorporation into tissue engineering scaffolds (cryogels, hydrogels, and electrospun scaffolds) 6
• Development of Manuka honey microneedles for enhanced wound treatment 7

These approaches remain experimental and require further clinical evaluation before consideration for routine use.

Clinical Recommendation

Based on the most recent and highest quality evidence:

1. Do not routinely use Manuka honey for diabetic foot ulcers or chronic wounds
2. Consider established evidence-based wound care approaches first
3. Be aware that Manuka honey supplements are not subject to the same FDA efficacy and safety standards as pharmaceuticals 1
4. Monitor for potential allergic reactions in patients with bee product allergies if Manuka honey is used 1

Practical Considerations

If Manuka honey is considered despite limited evidence:

• Quality and composition vary significantly based on bee feeding source, harvesting conditions, and geographic origin 1
• The processing method of honey products may impact their therapeutic properties 7
• Cost-effectiveness is questionable given the expense of medical-grade Manuka honey products and lack of proven superior outcomes

Healthcare providers should prioritize evidence-based wound care approaches with stronger supporting data until more robust clinical evidence emerges for Manuka honey.