Medihoney for Chronic Wound Management
Primary Recommendation
Do not use Medihoney (honey or bee-related products) for wound healing in diabetic foot ulcers, pressure ulcers, or venous leg ulcers, as this is strongly contraindicated by current evidence-based guidelines. 1
Evidence-Based Rationale
The International Working Group of the Diabetic Foot (IWGDF) 2024 guidelines provide a strong recommendation against using honey or bee-related products for wound healing purposes, with low certainty of evidence. 2, 1 This represents the highest quality and most recent guideline evidence available, superseding older observational studies.
Why This Recommendation Exists
Lack of high-quality evidence: Despite some small observational studies showing potential benefit 3, 4, rigorous randomized controlled trials have not demonstrated superiority over standard wound care 1
Potential to delay appropriate care: Using Medihoney may divert attention from evidence-based interventions that actually improve morbidity and mortality outcomes 1
Strong consensus across guidelines: The IWGDF guidelines, representing international expert consensus, explicitly list honey products among therapies that should NOT be used 2, 1
What Should Be Used Instead
Standard of Care Components (First-Line)
Sharp debridement should be performed to remove necrotic tissue, slough, and surrounding callus as the foundation of wound care. 2, 5 The frequency should be determined by clinical need rather than a fixed schedule. 5
Offloading is critical for diabetic foot ulcers:
- Use non-removable knee-high offloading devices as first-line treatment for neuropathic plantar ulcers 5, 6
- For limited access situations, consider felted foam with appropriate footwear 5, 6
Basic wound dressings that absorb exudate and maintain a moist healing environment should be used. 5 However, do not use topical antiseptic or antimicrobial dressings solely for wound healing (only for infection control). 1, 5
Adjunctive Therapies (Only After Standard Care Fails)
If insufficient improvement occurs after 2 weeks of optimal standard care 5:
Consider sucrose-octasulfate impregnated dressing for non-infected, neuro-ischemic ulcers (conditional recommendation, moderate certainty). 5
Consider autologous leucocyte, platelet, and fibrin patch where standard care has been ineffective and resources exist for regular venepuncture (conditional recommendation, moderate certainty). 2, 5
Consider hyperbaric oxygen therapy for neuro-ischemic or ischemic diabetic foot ulcers where standard care has failed and resources already exist (conditional recommendation, low certainty). 2, 5
Consider negative pressure wound therapy only for post-surgical diabetic foot wounds, NOT for non-surgical chronic ulcers (strong recommendation against the latter). 2, 1
Critical Pitfalls to Avoid
Failing to optimize standard care first: The most common error is using advanced or alternative therapies before ensuring adequate offloading, debridement, and basic wound care. 1, 5
Using antimicrobial products without infection: Topical antiseptics should only be used for infection control, not to accelerate healing. 1, 5
Premature use of unproven therapies: Medihoney and other honey products lack the evidence base to justify their use when proven interventions exist. 1
Clinical Context
While two small studies showed some positive results with Medihoney in pressure ulcers 3 and leg ulcers 4, these were observational studies with significant methodological limitations. The IWGDF systematic review process, which evaluated all available evidence through 2023, concluded that honey products should not be used. 2, 1 When guideline evidence directly contradicts small observational studies, the guideline recommendation takes precedence, especially when it represents international expert consensus based on comprehensive systematic review.