What are the benefits of using honey in medical settings, particularly for wound care and cough suppression in patients with conditions such as diabetic foot ulcers or impaired immune systems?

Medical Uses of Honey: Current Evidence Does Not Support Routine Clinical Use

Based on the most recent and highest quality guidelines, honey should not be used for wound healing in medical settings, particularly for diabetic foot ulcers, as the evidence shows no clear benefit despite widespread historical use. 1, 2

Strongest Evidence Against Routine Use

The International Working Group on the Diabetic Foot (IWGDF) 2024 guidelines provide the most definitive position, issuing a strong recommendation against using honey or bee-related products for wound healing in diabetes-related foot ulcers, based on low-quality evidence. 1, 2

Key Findings from High-Quality Studies:

• All six randomized controlled trials evaluating honey or bee products were deemed at high risk of bias, making any positive results unreliable. 1

• The only blinded study (using royal jelly) found no difference in healing over 12 weeks compared to placebo. 1

• No studies reported data on amputation rates, cost-effectiveness, or quality of life improvements with honey use. 1

Specific Clinical Contexts Where Honey Fails to Show Benefit

Diabetic Foot Ulcers

• Multiple studies comparing honey dressings with conventional treatments (saline-soaked gauze, iodine, povidone) found no significant differences in healing rates or amputation prevention. 1

• One larger unblinded study (338 subjects) reported apparent improvement, but was analyzed per protocol rather than intention-to-treat and lacked proper blinding, making results unreliable. 1

• A Cochrane review from 2015 concluded that effects of honey relative to comparators on healing were unclear and suggested health services avoid routine use until sufficient evidence exists. 1

Nasal/Sinus Applications

• Three studies evaluated honey addition to saline irrigation or spray for rhinosinusitis. 1

• None found any relevant differences between honey-treated groups and placebo groups. 1

• All patients also received oral antibiotics and/or nasal corticosteroids, which reduced the possibility of finding significant differences. 1

Why the Evidence Is Insufficient

Methodological Problems:

• Lack of blinding in most studies introduces significant bias. 1

• Small sample sizes and short follow-up periods limit generalizability. 1

• Significant heterogeneity in wound types, honey preparations, and standard care provided makes comparison between studies impossible. 1, 3

• No two studies evaluated the same honey product, preventing meta-analysis. 3

Theoretical vs. Clinical Reality:

• While honey possesses anti-inflammatory and antimicrobial properties in vitro, this has not translated to clinically meaningful outcomes in controlled trials. 1

• Laboratory evidence of antibacterial activity does not establish efficacy for actual wound healing in patients. 4, 5

Common Clinical Pitfalls to Avoid

• Do not confuse safety with efficacy: Honey is generally safe with minimal adverse effects, but safety alone does not justify use without proven benefit. 1, 3

• Do not rely on historical use: Despite 2,000+ years of traditional use, modern evidence-based standards require controlled trial data. 6, 7

• Do not substitute honey for evidence-based care: Standard wound care (appropriate offloading, moisture control, infection management) should never be replaced with unproven interventions. 1, 3

What to Use Instead

For diabetic foot ulcers specifically, the IWGDF recommends:

• Appropriate offloading as the primary intervention. 1

• Standard moisture-control dressings (basic contact or advanced dressings based on exudate level). 1

• Sucrose-octasulfate impregnated dressings for non-infected neuro-ischemic ulcers that fail to respond to standard care after 2 weeks (this has high-quality RCT evidence with low risk of bias). 1

Resource and Practical Considerations

• Resource use for honey products is similar to standard care, but without demonstrated benefit, expenditure cannot be justified. 1, 3

• No formal cost-effectiveness data exists for honey in wound healing. 1, 3

• Lack of standardization in honey products raises concerns about consistency in clinical applications. 2

Bottom Line for Clinical Practice

Despite widespread marketing and historical use, current high-quality guidelines uniformly recommend against using honey for wound healing in medical settings. 1, 2 The balance of effects does not favor the intervention, and the certainty of any benefit is very low. 1 Focus instead on evidence-based wound care interventions with proven efficacy for improving patient outcomes. 1