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WOUND CARE
PU
Effectiveness of a Honey Dressing for
Healing Pressure Ulcers
Ülkü Yapucu Günes¸  İsmet Eş er
OBJECTIVE: To compare the effect of a honey dressing vs an
ethoxy-diaminoacridine plus nitrofurazone dressing in patients
with pressure ulcers.
DESIGN: This 5-week randomized clinical trial evaluated the
effect of a honey dressing on pressure ulcer healing.
SETTING AND SUBJECTS: Thirty-six patients with a total of 68 stage
II or III pressure ulcers referred from a university hospital in
İzmir were enrolled in the study. Twenty-six subjects com-
pleted the trial.
INSTRUMENTS: Ulcers were measured with acetate tracings and
Pressure Ulcer Scale for Healing (PUSH) evaluations.
METHODS: Fifteen patients with 25 pressure ulcers were treated
with honey dressings, and 11 patients with 25 pressure ulcers
were treated with ethoxy-diaminoacridine plus nitrofurazone
dressings. Wound healing was assessed weekly using the PUSH
tool, version 3.0. The primary outcome measure was the change
in PUSH tool scores in each group at 5 weeks.
RESULTS: The two groups were statistically similar with regard to
baseline and wound characteristics. After 5 weeks of treatment,
patients who were treated by honey dressing had significantly
better PUSH tool scores than subjects treated with the ethoxy-
diaminoacridine plus nitrofurazone dressing (6.55 ± 2.14 vs
12.62 ± 2.15, P < .001).
CONCLUSION: By week 5, PUSH tool scores showed that healing
among subjects using a honey dressing was approximately
4 times the rate of healing in the comparison group. The use of
a honey dressing is effective and practical.
P ressure ulcers (PU) are lesions caused by unrelieved
pressure or shear resulting in damage to underlying
tissues. They are costly to both patients and healthcare
systems, and they are associated with significant human
suffering. As the population ages and the number of pa-
tients receiving care for acute illness increases, the preva-
lence of PU will continue to rise.1,2 Besides pressure relief,
nutritional support, and management of associated health
problems, local wound management is critical for pressure
ulcer healing.3 As part of the emphasis on topical wound
management, interest in honey, an ancient remedy, has
been renewed.4,5
184 J WOCN ■ March/April 2007 Copyright © 2007 by the Wound, Ostomy and Continence Nurses Society
J Wound Ostomy Continence Nurs. 2007;34(2):184-190.
Published by Lippincott Williams & Wilkins
■ Literature Review
The use of honey as a wound dressing material is growing
as more reports of its effectiveness are published. Clinical
observations suggest that honey may help the body clear in-
fection of the wound bed; reduce inflammation, swelling,
and pain; control odor; provoke sloughing of necrotic tis-
sue; enhance granulation and epitheliazation; and promote
wound healing with minimal scarring.6,7
The antimicrobial properties of honey prevent micro-
bial growth and preserve a moist healing environment.7,8
However, in contrast to many other topical antiseptics,
honey causes no tissue damage. Animal model studies
demonstrated that honey promotes wound healing by a
direct nutrient effect, as well as drawing lymph into the
wound by osmosis.7,8 The osmosis creates a solution of
honey in contact with the wound surface, which prevents
the dressing adhering to the wound bed or periwound
skin, so there is no pain or tissue damage when dressings
are changed.4,5 The acidity of honey may also stimulate
healing.5
Several clinical trials have been conducted that used
honey for a variety of wounds. Efem9 used unprocessed
honey (floral source not specified) to treat 50 patients with
recalcitrant wounds and ulcers. Forty-seven (80%) had
been treated with conventional treatments, including
commercial wound dressings or systemic and topical an-
tibiotics, and were considered to be indolent. After topical
application of honey, 58 of the 59 cases improved and in-
fected wounds were described as “sterile” within 1 week of
application of unprocessed honey.
Subrahmanyam10 completed a prospective randomized
trial comparing an amniotic membrane dressing with
honey-impregnated gauze in patients with partial-thickness
burns; 40 subjects were managed with the honey dressing
and 24 with the amniotic membrane. Subjects treated with
 Ülkü Yapucu Güneş, PhD, Assistant Professor, Ege University
School of Nursing, İzmir/Turkey.
 İsmet Eşer, PhD, Associated Professor, Ege University School of
Nursing, İzmir/Turkey.
Corresponding author: Ülkü Yapucu Güneş, Ege University School
of Nursing, 35100, İzmir/Turkey (e-mail: ulku.gunes@ege.edu.tr).
10371-11_WJ3402-Günes.qxd 3/5/07 2:41 PM Page 185
J WOCN ■ Volume 34/Number 2
honey-impregnated gauze healed faster than those managed
with the amniotic membrane (9.4 days vs 17.5 days), and
they were less likely to have residual scars (8% vs 16.6%).
Two case series reported positive effects when topical
unprocessed honey (Manuka honey) was used for topical
management of Fournier’s gangrene.11,12 Efem11 reported
41 consecutive cases of men with Fournier’s gangrene man-
aged with systemic antimicrobials and topical management
of gangrenous skin. Twenty-one patients were managed by
a variety of physicians with systemic antibiotics, wound de-
bridement, and excision and surgical repairs as indicated. A
second group of 20 patients was managed with antibiotics
and daily topical application of 15 mL to 30 mL of un-
processed honey applied to gangrenous ulcerations. An
additional 10 cases were managed by honey-soaked gauze.
Application of honey reduced foul odor, edema, and dis-
charge within 7 days. In 19 cases, scrotal ulcerations healed
without the need for subsequent surgical repair, and 1 case
was managed by application of honey and secondary
wound suturing alone. Although those managed by honey
and systemic antibiotics had longer hospital stays than
those managed by surgical debridement, no patient in this
group died. In contrast, 3 patients in the surgical debride-
ment group died, despite aggressive treatment.
Hejase and colleagues12 reported a case series of 38 pa-
tients admitted to the hospital between 1993 and 1995 for
treatment of Fournier’s gangrene. All subjects were treated
with broad-spectrum antimicrobials, and all underwent
aggressive surgical débridement. In addition, unprocessed
honey was applied to the wounds of all patients over a 2-
week period. The authors noted that topical therapy con-
tributed to wound healing in a mean period of 10 days
without evidence of secondary infection.
Mısırlıoğlu and associates13 compared the effect of
honey-impregnated gauze (floral source not specified) with
hydrocolloid and saline-soaked gauze dressings for the
treatment of split-thickness skin graft donor sites in a non-
randomized prospective trial. The donor graft site was di-
vided into 2 equal halves in 44 patients. One half was
managed with honey-soaked gauze dressings and the other
half with paraffin gauze, hydrocolloid dressings, and saline-
soaked gauzes. A second group of 44 subjects with 2 donor
sites had 1 site treated with honey-soaked gauze, and the
other site was managed with paraffin gauze, hydrocolloid
dressings, or saline-soaked gauze. Graft sites treated with
honey-soaked gauze demonstrated faster epithelialization
and were associated with less pain than paraffin gauze
or saline-soaked gauze; these differences were statistically
significant, but significant differences were demonstrated
when honey-soaked gauze was compared to hydrocolloid
dressings.
Subrahmanyam14 compared honey-impregnated gauze
with polyurethane film dressing (OpSite, Smith & Nephew
Wound Management Division, Largo, FL) as a cover for
partial-thickness burns in a randomized clinical trial in-
volving 92 patients with partial-thickness wounds involv-
Güneş & Eş er 185
ing less than 40% of body surface. Half of the subjects (n =
46) were randomly allocated to treatment with sterile
honey-impregnated gauze (floral source unspecified) after
the wound was cleansed with normal saline. The other half
were managed by cleansing with saline, followed by appli-
cation of a moisture permeable, bio-occlusive polyurethane
dressing (OpSite, Smith & Nephew Wound Management
Division, Largo, FL). Honey-impregnated dressings were
changed on day 2 and on alternate days (provided there was
no evidence of infection) until the wound was healed.
Subjects managed by OpSite were observed for evidence
of infection, excessive exudate, or leakage. If no evidence
of infection was observed, the polyurethane dressing
was changed on day 8 and a culture swab was obtained.
Adjunctive management of wounds was similar for both
groups. Wounds managed by honey-impregnated gauze
healed significantly earlier than those managed by the
polyurethane dressing (mean 10.8 days vs 15.3 days, P < .01).
At baseline, 10 burn wounds in the honey gauze group were
infected and 8 were infected at day 8 of treatment. In con-
trast, 9 wounds allocated to the polyurethane group were
infected at baseline and 17 were infected at day 8 of treat-
ment. This difference was also statistically significant.
Fifty patients with postoperative wound infections
after caesarean section or hysterectomy were managed
with either topical application of honey twice daily (n = 26)
or local antiseptics, 70% ethanol and povidone-iodine (n =
24). Patients managed by honey experienced eradication of
infection after a mean of 6 days, compared to a mean of
14.8 days in those managed by ethanol and povidone-
iodine, and they required fewer days of systemic antibiotics.
In addition, 84% of subjects managed with topical honey
showed complete wound healing without dehiscence or re-
quiring additional suturing, compared to 50% in the group
managed by ethanol and povidone-iodine.
Subrahmanyam16 randomized 25 subjects with partial-
thickness burn wounds to topical treatment with honey or
sulfadiazine (SSD), a topical antimicrobial agent commonly
used to treat partial-thickness burns. He found honey dress-
ings did not cause adhesion of the dressing to the wound,
preventing pain for the patient and damage to the granu-
lating surface of the wound. Eighty-four percent of patients
treated with honey showed satisfactory epithelialization
after 7 days, and all achieved satisfactory epithelialization
by 21 days. In contrast, 52% of wounds treated with SSD
demonstrated adequate epithelization by 7 days and 84%
within 21 days. Based on these findings, he concluded that
honey was as effective as or more effective than SSD, one of
the most common topical burn treatments used.
Numerous reports have indicated the effectiveness of
topical antibiotics for treatment of infection in wounds.17
However, many clinicians and researchers question the
routine use of topical antibiotics because of the risk of de-
velopment of resistance and possibility of hypersensitivity
reactions.17-19 Topical application of a combination of ni-
trofurazone and ethoxy-diaminoacridine in contaminated
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186 Güneş & Eş er
wounds is widely used in Turkey with considerable suc-
cess,20 but the literature and data to support this mode of
therapy are lacking. Although some reports in the literature
support the topical use of this antiseptic agent in wounds,17
clinical evidence supporting its safety and efficacy is mixed.
For example, Boyce and coworkers21 demonstrated dose-
dependent toxicity to human cells and limited effective-
ness against gram-negative microorganisms when serial
wound biopsies were used to determine the effect of a dress-
ing containing nitrofurazone 0.02% (Acticoat, Westaim
Biomedical, Exeter, NH) for burn wounds managed by cul-
tured skin substitutes. Other reports have also indicated
potential negative effects of nitrofurazone on wound
healing.21-23 A literature review revealed no published
studies focusing on ethoxy-diaminoacridine effects on
wound healing despite its frequent topical use for wound
care in Turkey.
■ Aim
The aim of this study was to compare the effect of honey
dressing vs ethoxy-diaminoacridine plus nitrofurazone
dressing on the healing of stage II or III PU. The authors
hypothesized that honey dressing was no more effective
than ethoxy-diaminoacridine plus nitrofurazone dressing
in the treatment of PU.
■ Methods
The authors completed a randomized parallel group
evaluation comparing honey dressing with an ethoxy-
diaminoacridine plus nitrofurazone dressing for the treat-
ment of pressure ulcers. Data were collected over a 5-week
period.
■ Subjects and Setting
Subjects who had Stage II or III PU and who were >18 years
of age were recruited from the university hospital in İzmir.
Thirty-six patients with a total of 68 stage II or III PU and
more than 2 months’ life expectancy were enrolled in this
study. If the patient had more than 1 PU, all PU were as-
sessed. Three patients with diabetes mellitus and 4 patients
with terminal illnesses were excluded. One patient declined
to participate. Therefore, 75% of the patients (n = 27) we ap-
proached met the inclusion criteria and were enrolled in the
study. Subsequently, 1 patient in the control group died. As
a result, the final analysis sample is drawn from 26 patients,
including 15 patients with 25 PU managed by honey and
11 patients with 25 PU managed by ethoxy-diaminoacri-
dine plus nitrofurazone dressings.
■ Instruments
PU measurements were made by standard acetate hand trac-
ings. Additional ulcer characteristics were documented via
the PUSH instrument, which was used to monitor wound
PU characteristics over time.24 The researchers measured ef-
J WOCN ■ March/April2007
ficacy parameters at baseline and on each weekly visit with
PUSH version 3.0.25 The validity and reliability of the PUSH
tool for measuring PU healing has been well established.26-29
The PUSH tool provides numeric scores for the param-
eters of exudate, wound surface area, and tissue type, which
are pertinent to wound healing. The total score can range
from 0 to 17, with 0 representing a healed wound. Data
from the PUSH tool were used to compare outcomes for
the honey-dressing group (treatment) to the ethoxy-
diaminoacridine plus nitrofurazone-dressing group (con-
trol). PUSH tool scores were calculated for all subjects at
baseline; these data were included in total results over time.
The primary end point with respect to efficacy in PU heal-
ing was change in total PUSH tool scores at week 5. PUSH
scores were determined by the principal investigator (UYG),
who is trained in the use of the instrument.
■ Procedures
Baseline assessments were done before randomization dur-
ing the first week after hospital admission. The authors col-
lected patient demographics, including information on age,
gender, body mass index, mobility level, and serum haemo-
globin level, and wound demographics include information
such as ulcer stage, ulcer surface area, and site of ulcer at the
initial screening from patients who met the study criteria.
The staging system recommended by the US Agency for
Health Care Research and Quality’s Pressure Ulcer Guide-
line Panel was used.2 Mobility levels were assessed using the
Braden Scale.30 After the baseline assessment, patients were
randomly stratified by age group, sex, and ulcer surface area
according to a computer-generated list. Fifteen patients
with 25 PU were treated by honey dressings, and 11 patients
with 25 PU were treated with ethoxy-diaminoacridine
plus nitrofurazone dressings. The researchers chose to use
a combination ethoxy-diaminoacridine and nitrofurazone
dressing because it is commonly used in Turkey to treat
wounds with significant bioburden or infection. The same
preventive skin regimen (a turning and repositioning pro-
gram and a pressure-relieving mattress) was initiated for all
patients before randomization. Treatment was continued
until the wound healed completely or for a maximum of
5 weeks.
The authors could not be blinded to the treatment.
Blinding would have required irrigation of the PU with ster-
ile 0.9% sodium chloride(NaCl) immediately before an
outcome assessor examined the wound. They needed to
identify the presence of exudate and slough, which could
not be done in a blinded study.
■ Honey-Dressing Protocol
Honey is produced from many different floral sources, and
its antibacterial activity varies with origin and processing.
Honey selected for clinical use should be evaluated on the
basis of antibacterial activity levels confirmed by laboratory
testing (range 0.25% to 25%).31 The researchers use un-
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J WOCN ■ Volume 34/Number 2
processed (raw, natural, organic, and unpasteurized) honey
obtained from one source. It differs from honey purchased
in the grocery store in several important ways. The mini-
mum inhibitory concentration of the honey used in this
study was 3.8%, indicating that the honey had sufficient
antibacterial potency to arrest bacterial growth. It was ster-
ilized via exposure to 25 kGy of gamma-irradiation.32 After
the wound was irrigated with 0.9% NaCl solution, a gauze
dressing impregnated with honey was used as a primary
dressing. A honey dressing of approximately 20 mL was ap-
plied on a 10 cm × 10 cm wound. A semipermeable adhe-
sive dressing was used as a secondary dressing to prevent
leakage of honey. Honey dressings were changed once daily
or when the dressing became contaminated with urine or
feces. Wounds were irrigated with 0.9% NaCl solution at
each dressing change. Provided the wound remained dry
and clean, dressings were changed every 2 days to maintain
a reservoir of antibacterial components capable of diffusing
into the wound bed. The authors ensured that honey dress-
ings were in full contact with the wound bed.
■ Ethoxy-Diaminoacridine Plus
Nitrofurazone Dressing Protocol
A second group of patients were managed with an ethoxy-
diaminoacridine and nitrofurazone dressing. The wound
was cleaned with ethoxy-diaminoacridine (0.1%) solution,
nitrofurazone cream was spread to surface of the wound,
and a dressing was applied. The surface of wound was
then covered with gauze dressing soaked with ethoxy-
diaminoacridine solution. A semipermeable adhesive dress-
ing was used as a secondary covering. Dressings were
changed once daily or whenever the dressing became con-
taminated with urine or feces.
■ Ethical Considerations
Informed consent approved by the ethical committee of
the authors’ hospital and the Ege University School of
Nursing was obtained from the patients or their designated
representatives. The researchers provided the same level of
TABLE 1.
Baseline Characteristics of Patients and Wounds in the Treatment and Control Groups*
Characteristics
Age
Men, n (%)
Mobility level†
Body mass index, kg/m2
Hemoglobin level, g/L
Stage of pressure ulcer
*Values expressed with a plus/minus sign are means ± SD. P > .05 for all comparisons.
†
Lower numbers indicate greater impairment (range, 1 to 4).
Güneş & Eş er 187
care to subjects in both groups. All patients received stan-
dard nursing interventions to optimize nutrition, activity,
and mobility and minimize moisture, friction, and shear.
All research procedures complied with the ethical rules for
human experimentation stated in the Declaration of
Helsinki.
■ Data Analysis
Data were analyzed according to a preestablished plan,
using the Statistical Package for the Social Sciences (version
11.0 for Windows). PUSH tool scores were used to charac-
terize PU healing in the treatment and control groups. Chi-
square (χ2) analysis was conducted to compare wound and
patient demographics by groups. Repeated ANOVA mea-
sures were calculated to compare PU healing in treatment
and control groups.
■ Results
The authors studied 26 patients with 50 stage II or III PU.
The average age of participants was 65.80 ± 6.30 in the treat-
ment group and 66.56 ± 5.53 in the control group. The lo-
cation of PU was also similar between groups; 12 ulcers in
both groups were at the sacrum, 3 ulcers in the treatment
group and 4 ulcers in the control group were at the shoul-
der, 5 ulcers in the treatment group and 2 ulcers in the con-
trol group were at trochanters, and 5 ulcers in the treatment
group and 7 ulcers in the control group were on the heel.
No statistically significant differences existed in group age,
gender, body mass index, mobility level, and serum hemo-
globin level between the study groups (χ2 = 1.408, 0.802,
5.013, 2.239, 0.518, respectively, all P > .05) (Table 1). There
were 25 PU in the treatment group (n = 15) and 25 PU in the
control group (n = 11). At baseline, 96 % of PU were stage
III and 4% were stage II in both groups.
PUSH tool scores over time are shown in Table 2. Mean
PUSH tool scores decreased in both groups over the 5-week
study, but the treatment group showed approximately
4 times the rate of PU healing as the control group (12.62 ±
2.15 vs 6.55 ± 2.14, P < .001). Patients managed by honey
Treatment Group (n = 15) Control Group (n = 11)
65.80 ± 6.30 66.56 ± 5.53
9 (60) 8 (72)
1.20 ± 0.40 1.32 ± 0.47
27.2 ± 1.38 26.4 ± 1.40
10.1 ± 1.97 11.9 ± 1.63
2.96 ± 0.20 2.96 ± 0.20
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188 Güneş & Eş er
TABLE 2.
Wound Healing Over Time as Measured by Mean Push
Tool Score
PUSH Tool Score
Honey-Dressing Control Group
Group (n = 25),
Week Mean (SD)
0 15.00 (1.50)
1 13.80 (1.91)*
2 11.08 (2.53)*
3 8.84 (2.53)*
4 7.02 (2.50)*
5 6.55 (2.12)*
*Rate of healing was significant in both groups over time; rate of healing
was significantly higher for the honey-dressing group across the 1-, 2-, 3-,
4-, and 5-week periods.
dressings also showed a statistically significant mean de-
crease in ulcer size at 5 weeks compared to patients man-
aged with ethoxy-diaminoacridine plus nitrofurazone
dressings (56% reduction vs 13% reduction, P < .001).
Complete healing was documented in 5 PU (all healing
ulcers were stage 3, 2 at the trochanters, 2 heel ulcers, and
1 sacral ulcer) within 5 weeks in the treatment group. No PU
in the control group healed completely (20% vs 0%; P <
.05). No subject in either group experienced adverse sys-
temic or local side effects directly attributed to treatment
with honey dressing or ethoxy-diaminoacridine plus nitro-
furazone dressings.
■ Discussion
This is the first randomized trial to investigate the effect of
honey dressing vs ethoxy-diaminoacridine plus nitrofura-
zone dressing on PU healing operationally defined as PUSH
tool scores. Figure 1 shows the cumulative changes in PUSH
tool scores over time. The cumulative improvement in
PUSH tool scores was more than 100% in the treatment
group. These findings are in agreement with the results of
previous studies showing that topical application of honey
accelerates wound healing.10-14,33,34
The researchers’ results with PU are similar to the re-
ported benefits of honey dressing in healing other chronic
wounds, including infected wounds.35-40 For example, one
study reported the use of honey on 9 infants with large in-
fected surgical wounds that failed to heal after 14 days of
IV antibiotic therapy, cleaning the wound with aqueous
0.05% chlorhexidine solution, and application of fusidic
acid ointment. Marked clinical improvement was seen in
all cases where 5-10 mL of unprocessed honey were applied
to the wounds twice daily for a period of 5 days, and all
wounds were closed, clean, and free of infection after
21 days of treatment.41
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J WOCN ■ March/April2007
10
PUSH Score
Improvemen t 5
0
Week s 1 2 3 4 5
(n = 25),
Mean (SD) Honey 1,2 3,92 6,16 7,98 8,45
Control 0,04 0,52 0,88 1,2 1,9
14.52 (1.81)
14.48 (1.81)
14.00 (2.12) FIGURE 1. Cumulative Improvement in Mean PUSH Tool
13.64 (2.14) Scores by Subject Over Time (Weeks)
13.32 (2.11) Subjects included all patients who completed the study
12.62 (2.15) (N = 26). Subjects had a total of 50 pressure ulcers, which were
measured weekly for 5 weeks using the Pressure Ulcer Scale
for Healing (PUSH), version 3.0. Values shown are based on
mean PUSH score changes weekly with standard deviation
from the mean.
The mechanisms responsible for the efficacy of honey
might beSu related to its antimicrobial activity and acid-
ity. Its antibacterial activity clears infection and applica-
tion appears to prevent wounds from becoming infected,
providing a moist healing environment while prevent-
ing excessive bacterial proliferation or infection.4,7,8 A moist
wound environment protects the wound, reduces infection
rates, reduces pain, débrides necrotic tissue, and promotes
granulation tissue formation. Moist wound dressings
enable epithelialization to occur along the top surface of the
wound, rather than underneath the scab, as occurs in dry
wounds, resulting in a pitted scar. The physical properties
of honey make it an ideal moist wound dressing. The high
viscosity of honey (which varies from floral source to floral
source) provides a protective barrier that is hypothesized to
prevent wounds from becoming infected.42 Its antiinflam-
matory activity reduces edema and exudate and prevents
or minimizes hypertrophic scarring. Honey also aids in re-
ducing odor in wounds by providing an alternative to the
amino acids from the serum and dead cells that are me-
tabolized by bacteria. This process gives rise to lactic acid
rather than ammonia, amines, and sulfur compounds that
lead to a malodorous wound.14,35,43 Similar to previous
studies,13 the authors found that honey dressings did not
adhere to the wound. Taken together, these factors make
honey an attractive treatment option for topical manage-
ment of PU.
■ Limitations
This trial had several limitations. First, the study was not
blinded as to treatment group. In addition, the study was
limited to stage II and III PU; additional research incorpo-
rating stage IV PU is needed. Variability exists in the potency
of the antimicrobial effects associated with unprocessed
honey because of such factors as hydrogen peroxide levels
10371-11_WJ3402-Günes.qxd 3/5/07 2:41 PM Page 189
J WOCN ■ Volume 34/Number 2
and floral origin. This variability may have influenced the
results of this study and may affect results when honey is
used in the clinical setting. The cytotoxicity of the anti-
microbial agents used in this study also may have affected
results. Finally, the authors believe that honey dressings
should be compared to alginate, hydrocolloid, and hydrogel
dressings to determine their efficacy in relation to these
commonly used topical treatment strategies for PU.
■ Conclusions
Treatment of PU with honey dressing significantly in-
creased the healing rate in comparison with ethoxy-
diaminoacridine plus nitrofurazone dressing. The treatment
was well tolerated by subjects, and the results support the
use of honey dressing for the treatment of stage II and III PU.
Nevertheless, further studies are warranted to better under-
stand the benefit of honey dressing in patients with PU and
its efficacy compared to advanced wound dressings.
KEY POINTS
✔ Honey is a traditional topical treatment for wounds. It can be
effective for the treatment of pressure ulcers.
✔ Because honey is produced from many different floral sources
and its antibacterial activity varies with origin and processing,
honey for clinical use should be selected according to its anti-
bacterial level.
■ References
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Department of Health and Human Services; 1994.
3. Bergstrom N, Bennett MA, Carlson CE. Treatment of pressure
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4. Molan P. Why honey is effective as a medicine, its use in
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5. Molan P. Potential of honey in the treatment of wounds and
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14. Subrahmanyam M. Honey impregnated gauze versus poly-
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randomized study. Br J Plast Surg. 1993;46:322-323.
15. Al-Waili NS, Saloom KY. Effects of topical honey on post-
operative wound infections due to gram positive and gram
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tomies. Eur J Med Res. 1999;4:126-130.
16. Subrahmanyam M. A prospective randomized clinical and
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