Medihoney Should Not Be Used for Diabetic Foot Ulcers
Do not use Medihoney or any honey-based products for treating your stage 2 foot ulcer, as current guidelines provide a strong recommendation against their use for diabetic foot ulcers. 1
Guideline-Based Recommendation
The most recent and authoritative guidance comes from the International Working Group on the Diabetic Foot (IWGDF) 2023 update, which explicitly states: "Do not use honey (or bee-related products) for the purpose of wound healing in diabetes-related foot ulcers" with a strong recommendation despite low certainty of evidence. 1 This represents a definitive position against honey use, even though the underlying evidence quality is limited.
The American College of Cardiology/American Heart Association 2024 guidelines on lower extremity peripheral artery disease similarly do not include honey among recommended wound care interventions for chronic limb-threatening ischemia. 1
Why Guidelines Recommend Against Honey
The strong recommendation against honey exists despite some positive research findings because:
- Insufficient high-quality evidence: While some studies suggest potential benefits, the overall body of evidence lacks the rigor needed to support routine clinical use 2, 3
- No significant advantage over standard care: A 2008 comparative trial found no statistically significant difference in healing time between honey dressing (14.4 days) and standard povidone-iodine dressing (15.4 days) 4
- Better alternatives exist: For non-healing ulcers after 2 weeks of standard care, sucrose-octasulfate impregnated dressings have moderate-quality evidence supporting their use 1, 5
What You Should Use Instead
Focus on evidence-based standard wound care:
- Sharp debridement of necrotic tissue and surrounding callus, performed as frequently as clinically needed 1
- Basic wound dressings selected primarily for exudate control, comfort, and cost 1
- Pressure offloading to remove mechanical stress from the ulcer site 1
- Optimize wound environment through moisture balance without antimicrobial agents unless infection is present 1
If standard care fails after 2 weeks, consider sucrose-octasulfate impregnated dressing for non-infected, neuro-ischemic ulcers, which has shown 48% complete healing at 20 weeks versus 30% with control dressing (adjusted OR 2.60,95% CI 1.43-4.73). 5
Common Pitfalls to Avoid
- Using antimicrobial dressings without infection: Guidelines strongly recommend against topical antiseptic or antimicrobial dressings for wound healing in non-infected diabetic foot ulcers 1
- Relying on unproven "natural" remedies: Despite honey's historical use and some positive case reports 6, 7, guidelines explicitly recommend against herbal remedies and bee-related products 1
- Neglecting revascularization assessment: Ensure adequate perfusion has been addressed, as wound care alone cannot heal ischemic ulcers 1
The Evidence Contradiction
While some research studies suggest honey may reduce wound recovery time and accelerate granulation 2, and case reports describe successful outcomes 6, 7, guideline committees have determined this evidence is insufficient to overcome the strong recommendation against use. The 2016 systematic review concluded that while honey appears safe, "there is insufficient good quality data to realistically conclude on the efficacy of honey on diabetic foot ulcers." 3
When guidelines and individual studies conflict, follow the guideline recommendation, as it represents expert synthesis of all available evidence with consideration of benefits, harms, and resource allocation. 1