Medihoney Should NOT Be Used for Diabetic Foot Ulcers or Chronic Wounds
The International Working Group on the Diabetic Foot (IWGDF) 2024 guidelines provide a strong recommendation against using honey or bee-related products (including Medihoney) for wound healing in diabetes-related foot ulcers. 1 This recommendation carries a "Strong" strength with "Low" certainty of evidence, meaning clinicians should not use these products regardless of individual patient circumstances.
Why Honey Is Not Recommended
The evidence base for honey in chronic wound management is fundamentally flawed:
Multiple randomized controlled trials evaluating honey products have been assessed as having high risk of bias, with methodologically poor study designs, small sample sizes, and short follow-up durations. 1
A 2015 Cochrane systematic review concluded that the effects of honey relative to comparators are unclear for venous leg ulcers, diabetic foot ulcers, and mixed chronic wounds, with very low to low quality evidence across all wound types. 2
The IWGDF 2020 guidelines noted that only three small controlled studies on honey were identified across multiple systematic reviews, with none showing convincing evidence of benefit. 1
A large multicentre RCT with low risk of bias found no difference between honey-containing dressings and standard dressings in terms of wound healing or infection prevention. 1
What the Guidelines Actually Recommend Instead
Select dressings based primarily on exudate control, comfort, and cost—not on antimicrobial properties or healing enhancement claims. 1, 3
The cornerstone of diabetic foot ulcer management includes:
Sharp debridement performed regularly based on clinical need (Strong recommendation; Low certainty). 1
Basic wound contact dressings that absorb exudate and maintain a moist wound healing environment—simple gauze or non-adherent dressings perform equally well as expensive specialized products. 1, 3
Proper off-loading of the ulcer, which is more critical than any dressing choice. 3, 4
No Recommended Dose or Duration Exists
Since honey is explicitly recommended against, there is no evidence-based dosing or duration protocol. The older research studies that attempted to use honey employed highly variable protocols:
One unblinded study used honey dressings for up to 3 months, but this study was analyzed per protocol (not intention-to-treat) and lacked proper blinding. 1
Individual case reports and small observational studies used honey for 7-35 days, but these do not constitute reliable evidence for clinical practice. 5, 6
Common Pitfalls to Avoid
Do not be swayed by marketing claims about honey's antimicrobial or anti-inflammatory properties—these theoretical benefits have not translated into improved clinical outcomes in properly designed trials. 1, 7
Do not use honey products based on historical or cultural precedent alone—ancient remedies require modern evidence of efficacy before adoption in contemporary wound care. 7
Avoid the misconception that "natural" products are inherently safer or more effective—the IWGDF explicitly recommends against herbal remedies and bee-related products. 1
Second-Line Options for Non-Healing Ulcers
If standard care (sharp debridement, basic dressings, proper off-loading) fails after at least 2 weeks:
Consider sucrose-octasulfate impregnated dressing for non-infected, neuro-ischemic diabetic foot ulcers (Conditional recommendation; Moderate certainty). 1, 3
Consider autologous leucocyte, platelet, and fibrin patch where resources and expertise exist (Conditional recommendation; Moderate certainty). 1, 4
The evidence is clear: honey products, including Medihoney, should not be used for diabetic foot ulcers or other chronic wounds. 1, 7 Focus instead on proven interventions—sharp debridement, appropriate off-loading, and basic moisture-retentive dressings selected for exudate control and cost-effectiveness.