Can Medihoney Be Changed Daily on Wounds?
Medical-grade honey (Medihoney) should NOT be used for wound healing in diabetes-related foot ulcers, and current guidelines recommend against its use for this purpose. 1 However, if honey dressings are being used in other wound contexts, daily changes are appropriate and safe based on general wound care principles.
Guideline Recommendations Against Honey Use
The most recent and authoritative guidance comes from the International Working Group on the Diabetic Foot (IWGDF) 2023 update, which provides a strong recommendation against using honey or bee-related products for wound healing in diabetes-related foot ulcers. 1 This represents the highest quality guideline evidence available (2024 publication) and should guide clinical decision-making for diabetic wounds.
If Honey Dressings Are Used: Frequency of Changes
General Wound Dressing Change Principles
For wounds where honey dressings might be considered (non-diabetic wounds), the following frequency guidelines apply:
Daily dressing changes are appropriate and recommended:
- Dressings should optimally be changed at least daily to apply a clean wound covering and allow careful examination of the wound for infection. 1
- Daily changes during the initial wound healing period are recommended to prevent infection and promote proper wound healing. 2
- Once-daily wound cleansing and dressing changes have been shown to be efficacious with no change in infectious morbidity, while reducing nursing time and pain medication requirements. 3
Specific Timing Considerations
Early wound care period (first week):
- Daily changes are recommended during the first week after wound creation. 2
- The wound should be monitored daily for signs of bleeding, erythema, induration, leakage, and inflammation. 2
After initial healing (beyond first week):
- Dressing changes can potentially be reduced to every 2-3 days once initial healing has occurred. 2
Factors requiring more frequent changes:
- Excessive wound exudate that saturates the dressing. 2
- Signs of infection (increased pain, erythema, purulent drainage, fever). 2
- Dressing becomes damp, loosened, or soiled. 2
Important Context on Biofilm and Infection Control
Biofilm can reform within 24-72 hours if left uninhibited, which supports the rationale for daily dressing changes in infected or at-risk wounds. 1 Medical-grade honey has been described as having properties to destroy and inhibit microorganism growth and prevent biofilm formation. 1 However, this theoretical benefit has not translated into clinical superiority in high-quality trials for diabetic foot ulcers.
Critical Pitfalls to Avoid
- Do not use honey dressings for diabetic foot ulcers - this is contraindicated by current guidelines with strong evidence. 1
- Avoid leaving dressings in place beyond 48 hours without inspection - this increases infection risk (relative risk 3.18 when left >4.5 days vs 48 hours). 4
- Do not use occlusive dressings over honey as they promote excessive moisture and can lead to skin maceration. 2
- Ensure proper wound cleansing with 0.9% sodium chloride solution, sterile water, or freshly boiled and cooled water at each dressing change. 2
- Complete drying of the wound area after cleansing is essential to prevent maceration of surrounding tissue. 2
Evidence Quality Note
While honey has historical use and some feasibility studies show it can be applied safely, 5 the highest quality systematic evidence for diabetic foot ulcers (the most common chronic wound type) demonstrates no benefit and recommends against its use. 1 The strength of this recommendation (Strong; Low certainty evidence) indicates that despite limited high-quality trials, the available evidence consistently shows no advantage, making it inappropriate for routine use.